Provider Demographics
NPI:1841517836
Name:SCHILLING, FREDERICK ROLAND (DDS)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:ROLAND
Last Name:SCHILLING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250, 2ND. AVE S.
Mailing Address - Street 2:STE 250
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2173
Mailing Address - Country:US
Mailing Address - Phone:612-338-4122
Mailing Address - Fax:
Practice Address - Street 1:250, 2ND. AVE S.
Practice Address - Street 2:STE 250
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2173
Practice Address - Country:US
Practice Address - Phone:612-338-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND92741223G0001X
173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No173F00000XOther Service ProvidersSleep Specialist, PhD
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6403190001Medicare NSC