Provider Demographics
NPI:1639291008
Name:SCHROEDER, TODD MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80344 STEEN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862-7314
Mailing Address - Country:US
Mailing Address - Phone:509-386-7940
Mailing Address - Fax:
Practice Address - Street 1:13 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:MILTON FREEWATER
Practice Address - State:OR
Practice Address - Zip Code:97862-1701
Practice Address - Country:US
Practice Address - Phone:541-938-0400
Practice Address - Fax:541-938-0440
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR81701223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR810619046OtherTIN