MEDICARE: SETH THOMAS SCHROEDER DDS

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	DDS-09425	IA
2	1223G0001X	General Practice Dentistry	D1226	SD

General Provider Information

NPI Number	:	1942739776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH THOMAS SCHROEDER DDS

Provider Business Mailing Address
First Line	:	225 N CLIFF AVE STE 2
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-2524
Country	:	US
Telephone Number	:	605-213-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 N CLIFF AVE STE 2
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-2524
Country	:	US
Telephone Number	:	605-213-1230
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	10/21/2022

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