Provider Demographics
NPI:1669213674
Name:SCHROEDER, PARIS NICOLE
Entity type:Individual
Prefix:
First Name:PARIS
Middle Name:NICOLE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 490TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51022-8005
Mailing Address - Country:US
Mailing Address - Phone:712-540-2519
Mailing Address - Fax:
Practice Address - Street 1:217 W 6TH ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1819
Practice Address - Country:US
Practice Address - Phone:712-732-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-102151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice