MEDICARE: DR. NICOLE SCHMIDT 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	2012019292	MO
2	122300000X	Dentist	019026147	IL

General Provider Information

NPI Number	:	1144347600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE SCHMIDT DDS

Provider Business Mailing Address
First Line	:	4045 N SAINT PETERS PKWY
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63304-7398
Country	:	US
Telephone Number	:	636-441-3466
Fax Number	:	636-441-5330

Provider Business Practice Location Address
First Line	:	4045 N SAINT PETERS PKWY
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63304-7398
Country	:	US
Telephone Number	:	636-441-3466
Fax Number	:	636-441-5330

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	04/28/2015

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