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General NPI Number Information
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NPI Number | 1740511344
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Entity Type | Individual
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Provider Name | ROBERT SCHROETLIN DDS, FACP
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Gender | Male
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 1215 E 6TH ST
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City | MOSCOW
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State | ID
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Zip | 83843-3705
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Country | US
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Telephone | 208-882-6570
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 3RD AVE
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City | CLARKSTON
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State | WA
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Zip | 99403-1315
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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 |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | D-4284
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | D9413
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DE00010231
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License Number State | WA
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