=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740657378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIMOTHY M. SCHROEDER DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2015
-----------------------------------------------------
Last Update Date | 08/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6565 W JEWELL AVE STE 3
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80232-7102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-937-6345
-----------------------------------------------------
Fax | 303-937-6331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6565 W JEWELL AVE STE 3
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80232-7102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-937-6345
-----------------------------------------------------
Fax | 303-937-6331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CATHY BELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-937-6345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 105018
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------