Provider Demographics
NPI:1457183089
Name:SCHRIEFER, KALYNN NICOLE (DMD)
Entity type:Individual
Prefix:
First Name:KALYNN
Middle Name:NICOLE
Last Name:SCHRIEFER
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 1:216 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:BEMENT
Mailing Address - State:IL
Mailing Address - Zip Code:61813-1321
Mailing Address - Country:US
Mailing Address - Phone:217-552-7965
Mailing Address - Fax:
Practice Address - Street 1:1006 S MARKET ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-1842
Practice Address - Country:US
Practice Address - Phone:217-762-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019035442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist