Provider Demographics
NPI:1609983394
Name:SCHWARTZ, ROBERT DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E FIRST STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-789-8070
Mailing Address - Fax:630-789-8071
Practice Address - Street 1:105 E FIRST STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-789-8070
Practice Address - Fax:630-789-8071
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
K02513Medicare ID - Type Unspecified
T37153Medicare UPIN
K02512Medicare ID - Type Unspecified
K02511Medicare ID - Type Unspecified