MEDICARE: DR. GARRETT STEVEN SCHNEIDER DDS

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	122300000X	Dentist	DS043246	PA

General Provider Information

NPI Number	:	1134899842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRETT STEVEN SCHNEIDER DDS

Provider Business Mailing Address
First Line	:	1101 LUDLOW ST APT 1820
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4281
Country	:	US
Telephone Number	:	718-974-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	12401 ACADEMY RD STE 201
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1934
Country	:	US
Telephone Number	:	215-632-1244
Fax Number	:

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

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/14/2021

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