Healthcare Provider Details

I. General information

NPI: 1689698797
Provider Name (Legal Business Name): ROBERT DEWAYNE SCHROEDER DENTUREST L.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NE 7TH ST
GRANTS PASS OR
97526-1420
US

IV. Provider business mailing address

1010 NE 7TH ST
GRANTS PASS OR
97526-1420
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-7483
  • Fax: 541-955-8029
Mailing address:
  • Phone: 541-476-7483
  • Fax: 541-955-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number174
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: