Provider Demographics
NPI:1659507515
Name:SCHRADER, EDWARD AUSTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:AUSTIN
Last Name:SCHRADER
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 1:6207 COTTAGE HILL RD STE E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3113
Mailing Address - Country:US
Mailing Address - Phone:251-666-3600
Mailing Address - Fax:
Practice Address - Street 1:6207 COTTAGE HILL RD STE E
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3113
Practice Address - Country:US
Practice Address - Phone:251-666-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist