Provider Demographics
NPI:1750644712
Name:SCHROEDER, KRISTIN ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ELAINE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 OLD CHENEY RD APT 6
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2839
Mailing Address - Country:US
Mailing Address - Phone:402-677-0491
Mailing Address - Fax:
Practice Address - Street 1:2936 S 86TH CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3099
Practice Address - Country:US
Practice Address - Phone:402-393-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist