MEDICARE: SCHOMMER DENTAL PC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1689334864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHOMMER DENTAL PC

Provider Business Mailing Address
First Line	:	2010 E 38TH ST STE 105
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-1179
Country	:	US
Telephone Number	:	563-355-5177
Fax Number	:	563-355-0884

Provider Business Practice Location Address
First Line	:	2010 E 38TH ST STE 105
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-1179
Country	:	US
Telephone Number	:	563-355-5177
Fax Number	:	563-355-0884

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. CLAYTON SCHOMMER
Credential	:	DMD
Telephone Number	:	563-355-5177

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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