Provider Demographics
NPI:1194006536
Name:SCHROEDER, MATTHEW CLARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CLARK
Last Name:SCHROEDER
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 1:134 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BIGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17307-9416
Mailing Address - Country:US
Mailing Address - Phone:717-677-8145
Mailing Address - Fax:717-677-7328
Practice Address - Street 1:134 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BIGLERVILLE
Practice Address - State:PA
Practice Address - Zip Code:17307-9416
Practice Address - Country:US
Practice Address - Phone:717-677-8145
Practice Address - Fax:717-677-7328
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038867122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice