MEDICARE: EUGENE J. 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	36281	CA

General Provider Information

NPI Number	:	1912042086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE J. SCHMIDT DDS

Provider Business Mailing Address
First Line	:	17928 MAGNOLIA ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5039
Country	:	US
Telephone Number	:	714-963-8934
Fax Number	:	714-962-7940

Provider Business Practice Location Address
First Line	:	17928 MAGNOLIA ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5039
Country	:	US
Telephone Number	:	714-963-8934
Fax Number	:	714-962-7940

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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