Healthcare Provider Details

I. General information

NPI: 1104207133
Provider Name (Legal Business Name): JEFFREY SCHMELTER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 W GUADALUPE RD STE 120
MESA AZ
85202-7484
US

IV. Provider business mailing address

2753 QUARRY VALLEY RD
COLUMBUS OH
43204-4974
US

V. Phone/Fax

Practice location:
  • Phone: 480-909-4255
  • Fax: 334-339-7349
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD9400
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: