Provider Demographics
NPI:1962523928
Name:SCHAUB, MATTHEW LEROY (DDS)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LEROY
Last Name:SCHAUB
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 1:5098 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9383
Mailing Address - Country:US
Mailing Address - Phone:734-761-1194
Mailing Address - Fax:734-761-9732
Practice Address - Street 1:5098 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9383
Practice Address - Country:US
Practice Address - Phone:734-761-1194
Practice Address - Fax:734-761-9732
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI176381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice