Provider Demographics
NPI:1790905289
Name:PETER J SCHINDELHOLZ, DDS SC
Entity Type:Organization
Organization Name:PETER J SCHINDELHOLZ, DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHINDELHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-547-3541
Mailing Address - Street 1:4453 COUNTY ROAD B
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54540-9705
Mailing Address - Country:US
Mailing Address - Phone:715-547-3541
Mailing Address - Fax:715-547-6659
Practice Address - Street 1:4453 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:WI
Practice Address - Zip Code:54540-9705
Practice Address - Country:US
Practice Address - Phone:715-547-3541
Practice Address - Fax:715-547-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty