Provider Demographics
NPI:1356558282
Name:SCHROEDER, NATHAN D (DMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:D
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5720 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4331
Mailing Address - Country:US
Mailing Address - Phone:309-682-1213
Mailing Address - Fax:309-682-5386
Practice Address - Street 1:5720 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4331
Practice Address - Country:US
Practice Address - Phone:309-682-1213
Practice Address - Fax:309-682-5386
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA301721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery