Healthcare Provider Details

I. General information

NPI: 1063480747
Provider Name (Legal Business Name): JASON SCHMIT D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 1ST AVE SE
CEDAR RAPIDS IA
52402-4844
US

IV. Provider business mailing address

2727 1ST AVE SE
CEDAR RAPIDS IA
52402-4844
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-3575
  • Fax: 319-363-8886
Mailing address:
  • Phone: 319-363-3575
  • Fax: 319-363-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number08029
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier08823
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerDELTA PROV #
# 2
Identifier0210112
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 3
Identifier170454
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerTRICARE PROV #
# 4
Identifier38294
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK PROVIDER #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: