Healthcare Provider Details

I. General information

NPI: 1639291008
Provider Name (Legal Business Name): TODD MICHAEL SCHROEDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 NE 5TH AVE
MILTON FREEWATER OR
97862-1701
US

IV. Provider business mailing address

80344 STEEN RD
MILTON FREEWATER OR
97862-7314
US

V. Phone/Fax

Practice location:
  • Phone: 541-938-0400
  • Fax: 541-938-0440
Mailing address:
  • Phone: 509-386-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number8170
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: