Provider Demographics
NPI:1316081599
Name:SCHROEDER, JOHN DANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANLEY
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 1:1304 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-4424
Mailing Address - Country:US
Mailing Address - Phone:319-372-8223
Mailing Address - Fax:319-372-8240
Practice Address - Street 1:1304 AVENUE G
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-4424
Practice Address - Country:US
Practice Address - Phone:319-372-8223
Practice Address - Fax:319-372-8240
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA56691223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics