Provider Demographics
NPI:1578853933
Name:RYAN SCHROEDER DDS PC
Entity Type:Organization
Organization Name:RYAN SCHROEDER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUST OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-665-5211
Mailing Address - Street 1:611 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097-3319
Practice Address - Country:US
Practice Address - Phone:810-387-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010920261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental