Provider Demographics
NPI:1528163474
Name:SCHUMACHER, PETER JOHN (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:SCHUMACHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:JOHN
Other - Last Name:SCHUMACHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2121 S WEBSTER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2290
Mailing Address - Country:US
Mailing Address - Phone:920-437-5771
Mailing Address - Fax:920-437-7202
Practice Address - Street 1:2121 S WEBSTER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2290
Practice Address - Country:US
Practice Address - Phone:920-437-5771
Practice Address - Fax:920-437-7202
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000829G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice