Provider Demographics
NPI:1073684205
Name:SCHELLENTRAGER, ROBERT C (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:SCHELLENTRAGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 CAPITOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2751
Mailing Address - Country:US
Mailing Address - Phone:831-475-2313
Mailing Address - Fax:831-475-9157
Practice Address - Street 1:617 CAPITOLA AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2751
Practice Address - Country:US
Practice Address - Phone:831-475-2313
Practice Address - Fax:831-475-9157
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice