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General NPI Number Information
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NPI Number | 1659524122
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Entity Type | Individual
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Provider Name | JACOB ALAN SCHUETTE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 2800 COLLEGE AVE
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City | ALTON
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State | IL
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Zip | 62002-4700
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Country | US
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Telephone | 618-474-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 TIMBERLAKE DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-4100
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Country | US
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Telephone | 618-402-8831
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2010016964
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-022854
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028313
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License Number State | IL
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