Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 8170 | OR |
NPI | 1639291008 |
---|---|
Provider Name | Dr. Todd Michael Schroeder |
First Address | Milton Freewater, OR 97862-7314 |
Second Address | Milton Freewater, OR 97862-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 13/09/2017 |