Provider Demographics
NPI:1740352095
Name:SCHREINER, MARK SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:SCOTT
Last Name:SCHREINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:S
Other - Last Name:SCHREINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1709 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702
Mailing Address - Country:US
Mailing Address - Phone:319-236-1742
Mailing Address - Fax:319-236-1742
Practice Address - Street 1:1709 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:319-236-1742
Practice Address - Fax:319-236-1742
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA64411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0161018Medicaid
0161018Medicare ID - Type Unspecified