Healthcare Provider Details

I. General information

NPI: 1881074425
Provider Name (Legal Business Name): JUSTIN SCHNEIDER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE STE 52
HIALEAH FL
33012-7193
US

IV. Provider business mailing address

601 NE 36TH ST APT 805
MIAMI FL
33137-3911
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-9899
  • Fax:
Mailing address:
  • Phone: 243-924-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.030289
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN26702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: