Healthcare Provider Details

I. General information

NPI: 1275539108
Provider Name (Legal Business Name): DAVID SCHUBERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24402 W LOCKPORT ST SUITE 200
PLAINFIELD IL
60544-4206
US

IV. Provider business mailing address

24402 W LOCKPORT ST SUITE 200
PLAINFIELD IL
60544-4206
US

V. Phone/Fax

Practice location:
  • Phone: 815-577-0700
  • Fax: 815-577-9670
Mailing address:
  • Phone: 815-577-0700
  • Fax: 815-577-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19A14977
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: