Provider Demographics
NPI:1700946613
Name:SCHREIBER, PAMELA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:SCHREIBER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:S
Other - Last Name:SCHREIBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DENTIST
Mailing Address - Street 1:400 COLUMBUS AVE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:203-503-6515
Practice Address - Street 1:400 COLUMBUS AVE
Practice Address - Street 2:DENTAL DEPARTMENT
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3040
Practice Address - Fax:203-503-3187
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6833OtherDENTIST
CT008031270Medicaid
CT0014279OtherCSR