Healthcare Provider Details

I. General information

NPI: 1124861752
Provider Name (Legal Business Name): ANDREW DAVID SCHAEDLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 113TH ST
SEMINOLE FL
33772-2800
US

IV. Provider business mailing address

13001 103RD AVE
LARGO FL
33774-5609
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-5050
  • Fax:
Mailing address:
  • Phone: 727-412-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29082
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDRPM2765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: