MEDICARE: DR. STEPHEN NICHOLAS SCHROEDER D.D.S.

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	1223G0001X	General Practice Dentistry	0401413581	VA
2	1223E0200X	Endodontics	0401413581	VA

General Provider Information

NPI Number	:	1477814408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN NICHOLAS SCHROEDER D.D.S.

Provider Business Mailing Address
First Line	:	114 VIRGINIA ST
Second Line	:	APARTMENT #311
City	:	RICHMOND
State	:	VA
Zip	:	23219-4124
Country	:	US
Telephone Number	:	434-222-6656
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 HUNGARY SPRING RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228
Country	:	US
Telephone Number	:	804-501-0501
Fax Number	:	804-501-0509

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	07/03/2018

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