Provider Demographics
NPI:1790988160
Name:SCHUBERT, PETRA (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6128 SHERRY LANE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6301
Mailing Address - Country:US
Mailing Address - Phone:214-987-0055
Mailing Address - Fax:214-987-9697
Practice Address - Street 1:6128 SHERRY LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6301
Practice Address - Country:US
Practice Address - Phone:214-987-0055
Practice Address - Fax:214-987-9697
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics