MEDICARE: DR. CRYSTAL GENEVA SCHNEIDER D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30-022962	OH

General Provider Information

NPI Number	:	1063678639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL GENEVA SCHNEIDER D.M.D

Provider Business Mailing Address
First Line	:	8224 MENTOR AVE
Second Line	:	SUITE 142
City	:	MENTOR
State	:	OH
Zip	:	44060-5768
Country	:	US
Telephone Number	:	440-974-4449
Fax Number	:

Provider Business Practice Location Address
First Line	:	8224 MENTOR AVE
Second Line	:	SUITE 142
City	:	MENTOR
State	:	OH
Zip	:	44060-5768
Country	:	US
Telephone Number	:	440-974-4449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	09/12/2010

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