Provider Demographics
NPI:1912087487
Name:SCHNEIDER, JOELLEN RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOELLEN
Middle Name:RAE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N HARBOR DR
Mailing Address - Street 2:1807
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7364
Mailing Address - Country:US
Mailing Address - Phone:773-315-5709
Mailing Address - Fax:
Practice Address - Street 1:4020 W 59TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4512
Practice Address - Country:US
Practice Address - Phone:773-585-5176
Practice Address - Fax:773-585-5188
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice