Provider Demographics
NPI:1922006089
Name:SCHOEMAKER, JEANE L (DDS)
Entity Type:Individual
Prefix:
First Name:JEANE
Middle Name:L
Last Name:SCHOEMAKER
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 1:105 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2011
Mailing Address - Country:US
Mailing Address - Phone:970-867-7245
Mailing Address - Fax:970-867-5818
Practice Address - Street 1:105 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2011
Practice Address - Country:US
Practice Address - Phone:970-867-7245
Practice Address - Fax:970-867-5818
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
CO65571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02065571Medicaid