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General NPI Number Information
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NPI Number | 1649546888
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Entity Type | Organization
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Legal Business Name | BRUCE A SCHRADER DDS PLLC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 3305 81ST ST STE D
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City | LUBBOCK
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State | TX
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Zip | 79423-2042
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Country | US
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Telephone | 806-745-8413
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 81ST ST STE D
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City | LUBBOCK
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State | TX
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Zip | 79423-2042
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Country | US
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Telephone | 806-745-8413
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CYNTHIA M SCHRADER
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Credential | CDA, COMSA, RDA
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Telephone | 806-745-8413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 16874
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License Number State | TX
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