MEDICARE: DR. JACOB A SCHLINDWEIN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		WI
2	1223G0001X	General Practice Dentistry	1001316 - 15	WI

General Provider Information

NPI Number	:	1639524929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB A SCHLINDWEIN D.D.S.

Provider Business Mailing Address
First Line	:	11345 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3411
Country	:	US
Telephone Number	:	262-241-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	11345 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3411
Country	:	US
Telephone Number	:	262-241-4440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	06/02/2016

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