Provider Demographics
NPI:1336377456
Name:SCHROTENBOER, JASON SEAN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SEAN
Last Name:SCHROTENBOER
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 W BELMONT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5170
Mailing Address - Country:US
Mailing Address - Phone:773-945-5005
Mailing Address - Fax:773-945-5004
Practice Address - Street 1:3927 W BELMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5170
Practice Address - Country:US
Practice Address - Phone:773-945-5005
Practice Address - Fax:773-945-5004
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030332204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery