Provider Demographics
NPI:1659524122
Name:SCHUETTE, JACOB ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ALAN
Last Name:SCHUETTE
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 1:1004 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4100
Mailing Address - Country:US
Mailing Address - Phone:618-402-8831
Mailing Address - Fax:
Practice Address - Street 1:2800 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4700
Practice Address - Country:US
Practice Address - Phone:618-474-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016964122300000X
OH30-022854122300000X
IL019028313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist