Basic Information
| Provider Information | |||||||||
| NPI: | 1568803278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHRAEDER | ||||||||
| FirstName: | PRESTON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 522 WEEPING WILLOW RD | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750442545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857600585 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5129 N GARLAND AVE STE 700 | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750402746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722765191 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 00204593 | CO | N | Dental Providers | Dentist | 122300000X | 29114 | TX | Y | Dental Providers | Dentist |
No ID Information.