Provider Demographics
NPI:1053690552
Name:SCHROEDER, SANDRA JEAN (DENTIAL HYGIENIST)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JEAN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DENTIAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6694 SAM HILL DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9384
Mailing Address - Country:US
Mailing Address - Phone:608-825-2956
Mailing Address - Fax:
Practice Address - Street 1:6694 SAM HILL DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9384
Practice Address - Country:US
Practice Address - Phone:608-825-2956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6706-16124Q00000X
IL020.007667124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist