Provider Demographics
NPI:1962029520
Name:SCHNEIDER, MACKENZIE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:ANN
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GARDNER AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-2160
Mailing Address - Country:US
Mailing Address - Phone:262-763-6921
Mailing Address - Fax:
Practice Address - Street 1:190 GARDNER AVE STE 5
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-2160
Practice Address - Country:US
Practice Address - Phone:262-763-6921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002339-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist