Provider Demographics
NPI:1144329129
Name:SCHRADER, RODERICK PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:PETER
Last Name:SCHRADER
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 1:9 WYNNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIG FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:14814-7909
Mailing Address - Country:US
Mailing Address - Phone:607-562-8689
Mailing Address - Fax:
Practice Address - Street 1:9 WYNNWOOD DR
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-7909
Practice Address - Country:US
Practice Address - Phone:607-562-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist