Healthcare Provider Details

I. General information

NPI: 1922737022
Provider Name (Legal Business Name): JEFFREY CHRISTOFFER SCHOOTMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N OUTER 40 RD
CHESTERFIELD MO
63005-1375
US

IV. Provider business mailing address

17300 N OUTER 40 RD STE 103
CHESTERFIELD MO
63005-1364
US

V. Phone/Fax

Practice location:
  • Phone: 636-536-5158
  • Fax: 636-536-4544
Mailing address:
  • Phone: 636-536-5158
  • Fax: 636-536-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2025027696
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES-30642
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: