Healthcare Provider Details

I. General information

NPI: 1396724308
Provider Name (Legal Business Name): BRIAN REX SCHNEIDER D.D.S. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRIAN REX SCHNEIDER D.D.S. M.D.

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 N TATUM BLVD SUITE F 100
PHOENIX AZ
85028-6073
US

IV. Provider business mailing address

11030 N TATUM BLVD SUITE F 100
PHOENIX AZ
85028-6073
US

V. Phone/Fax

Practice location:
  • Phone: 602-996-2225
  • Fax: 602-996-8048
Mailing address:
  • Phone: 602-996-2225
  • Fax: 602-996-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901017378
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7629
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: