Healthcare Provider Details

I. General information

NPI: 1255790580
Provider Name (Legal Business Name): CARLY (CAROL) SCHNEIDER RDH; COM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 LOMITA DR SUIT D
MILL VALLEY CA
94941-1451
US

IV. Provider business mailing address

147 LOMITA DRIVE SUIT D
MILL VALLEY CA
94941
US

V. Phone/Fax

Practice location:
  • Phone: 415-888-8691
  • Fax: 415-888-8691
Mailing address:
  • Phone: 415-888-8691
  • Fax: 415-888-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: