Healthcare Provider Details

I. General information

NPI: 1114592300
Provider Name (Legal Business Name): MAURICIO SCHNEIDER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3841 TREE TOP DR
WESTON FL
33332-2139
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1303
  • Fax: 954-262-1782
Mailing address:
  • Phone: 786-238-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDTP721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: