Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 019030332 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 019030332 | IL |
NPI | 1336377456 |
---|---|
Provider Name | Dr. Jason Sean Schrotenboer |
First Address | Chicago, IL 60618-5170 |
Second Address | Chicago, IL 60618-5170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 09/11/2021 |