Provider Demographics
NPI:1336360718
Name:SCHAUMBERG, JOEL P (DDS)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:P
Last Name:SCHAUMBERG
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 1:1345 DELMONTE ST
Mailing Address - Street 2:
Mailing Address - City:WOLVERINE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1910
Mailing Address - Country:US
Mailing Address - Phone:248-669-6622
Mailing Address - Fax:248-473-0350
Practice Address - Street 1:25874 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1445
Practice Address - Country:US
Practice Address - Phone:248-473-8822
Practice Address - Fax:248-473-0350
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist