Provider Demographics
NPI:1063568954
Name:SCHNEIDER, ROBERT EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20620 N PARK BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4519
Mailing Address - Country:US
Mailing Address - Phone:216-321-2545
Mailing Address - Fax:216-321-2546
Practice Address - Street 1:20620 N PARK BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4519
Practice Address - Country:US
Practice Address - Phone:216-321-2545
Practice Address - Fax:216-321-2546
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH193251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice