Provider Demographics
NPI:1992978779
Name:SCHRUBBE, THEODORE GLENN (DDS)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:GLENN
Last Name:SCHRUBBE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RED BARN LN
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-1958
Mailing Address - Country:US
Mailing Address - Phone:414-975-6668
Mailing Address - Fax:
Practice Address - Street 1:1150 RED BARN LN
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-1958
Practice Address - Country:US
Practice Address - Phone:414-975-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice