Provider Demographics
NPI:1992718019
Name:SCHROEDER, DONNA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:SCHROEDER
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 1:3600 TOWER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5337
Mailing Address - Country:US
Mailing Address - Phone:715-392-5411
Mailing Address - Fax:715-392-5086
Practice Address - Street 1:3600 TOWER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5337
Practice Address - Country:US
Practice Address - Phone:715-392-5411
Practice Address - Fax:715-392-5086
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN505020500Medicaid
WI33467600Medicaid
WI3346OtherLICENSE