Provider Demographics
NPI:1154431872
Name:SCHWEITZER, PAMELA SUE (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:SCHWEITZER
Suffix:
Gender:F
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:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:IA
Mailing Address - Zip Code:52159-0858
Mailing Address - Country:US
Mailing Address - Phone:563-539-2025
Mailing Address - Fax:563-539-2025
Practice Address - Street 1:100 SOUTH PAGE STREET
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:IA
Practice Address - Zip Code:52159-0858
Practice Address - Country:US
Practice Address - Phone:563-539-2025
Practice Address - Fax:563-539-2025
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0152330Medicaid