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General NPI Number Information
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NPI Number | 1073956017
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Entity Type | Organization
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Legal Business Name | KATHLEEN A. SCHROEDER DDS
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 278 MEMORIAL DR
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6246
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Country | US
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Telephone | 815-455-3110
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Fax | 815-455-7302
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Provider Business Mailing Address
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Address Line | 278 MEMORIAL DR
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6246
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT GOLDMAN
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Credential |
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Telephone | 847-987-0322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019015377
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License Number State | IL
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