Provider Demographics
NPI:1689698797
Name:SCHROEDER, ROBERT DEWAYNE (DENTUREST LD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DEWAYNE
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DENTUREST LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1420
Mailing Address - Country:US
Mailing Address - Phone:541-476-7483
Mailing Address - Fax:541-955-8029
Practice Address - Street 1:1010 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1420
Practice Address - Country:US
Practice Address - Phone:541-476-7483
Practice Address - Fax:541-955-8029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR127824OtherOMAP