Provider Demographics
NPI:1194768572
Name:SCHINDELHOLZ, PETER JOHN (DDS)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:SCHINDELHOLZ
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 1:4453 HIGHWAY B
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54540
Mailing Address - Country:US
Mailing Address - Phone:715-547-3004
Mailing Address - Fax:715-547-6659
Practice Address - Street 1:4453 HIGHWAY B
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:WI
Practice Address - Zip Code:54540
Practice Address - Country:US
Practice Address - Phone:715-547-3004
Practice Address - Fax:715-547-6659
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist