Healthcare Provider Details

I. General information

NPI: 1124285309
Provider Name (Legal Business Name): LYNN MARIE SCHMADER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 COLLEGE
BOURBON MO
65441-0129
US

IV. Provider business mailing address

PO BOX 129
BOURBON MO
65441-0129
US

V. Phone/Fax

Practice location:
  • Phone: 573-732-5505
  • Fax:
Mailing address:
  • Phone: 573-732-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number015332
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: