Provider Demographics
NPI:1386800878
Name:SCHRADER, BROOKE WEBER (DMD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:WEBER
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 STONEHENGE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1620
Mailing Address - Country:US
Mailing Address - Phone:919-848-3588
Mailing Address - Fax:919-846-3500
Practice Address - Street 1:7200 STONEHENGE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1620
Practice Address - Country:US
Practice Address - Phone:919-848-3588
Practice Address - Fax:919-846-3500
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC89801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program