MEDICARE: DR. JASON SEAN SCHROTENBOER DDS, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	019030332	IL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	019030332	IL

General Provider Information

NPI Number	:	1336377456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON SEAN SCHROTENBOER DDS, MD

Provider Business Mailing Address
First Line	:	3927 W BELMONT AVE STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5170
Country	:	US
Telephone Number	:	773-945-5005
Fax Number	:	773-945-5004

Provider Business Practice Location Address
First Line	:	3927 W BELMONT AVE STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5170
Country	:	US
Telephone Number	:	773-945-5005
Fax Number	:	773-945-5004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	11/09/2021

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