Healthcare Provider Details

I. General information

NPI: 1497838809
Provider Name (Legal Business Name): GERALD J. SCHNEEBERGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 SOUTH BELLEW AVENUE
WATERTOWN NY
13601
US

IV. Provider business mailing address

163 SOUTH BELLEW AVENUE
WATERTOWN NY
13601
US

V. Phone/Fax

Practice location:
  • Phone: 315-786-3990
  • Fax: 315-786-3991
Mailing address:
  • Phone: 315-786-3990
  • Fax: 315-786-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number042104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: