Provider Demographics
NPI:1053934851
Name:SCHADE, STEVEN KEVIN (DMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:KEVIN
Last Name:SCHADE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3919
Mailing Address - Country:US
Mailing Address - Phone:801-995-2466
Mailing Address - Fax:
Practice Address - Street 1:2288 E MAIN ST UNIT C
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-4230
Practice Address - Country:US
Practice Address - Phone:970-564-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist