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General NPI Number Information
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NPI Number | 1780255844
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Entity Type | Individual
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Provider Name | DR. JACOB JAMES SCHROEDER
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Gender | Male
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1901 SOUTH ST STE 2
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City | DULUTH
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State | MN
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Zip | 55812-2117
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Country | US
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Telephone | 218-727-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 4032 GILLIAT ST
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City | DULUTH
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State | MN
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Zip | 55804-2138
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Country | US
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Telephone | 763-377-3063
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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 | D14624
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D14624
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License Number State | MN
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