Provider Demographics
NPI:1649546888
Name:BRUCE A SCHRADER DDS PLLC
Entity type:Organization
Organization Name:BRUCE A SCHRADER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:CDA, COMSA, RDA
Authorized Official - Phone:806-745-8413
Mailing Address - Street 1:3305 81ST ST
Mailing Address - Street 2:STE D
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2042
Mailing Address - Country:US
Mailing Address - Phone:806-745-8413
Mailing Address - Fax:
Practice Address - Street 1:3305 81ST ST
Practice Address - Street 2:STE D
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2042
Practice Address - Country:US
Practice Address - Phone:806-745-8413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16874261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental