Healthcare Provider Details

I. General information

NPI: 1528767373
Provider Name (Legal Business Name): DAVID E. SCHMIDT, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S WAUKEGAN RD STE A1
LAKE FOREST IL
60045-2665
US

IV. Provider business mailing address

825 S WAUKEGAN RD STE A1
LAKE FOREST IL
60045-2665
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-4800
  • Fax: 847-234-4876
Mailing address:
  • Phone: 847-234-4800
  • Fax: 847-234-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ERIC SCHMIDT
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 847-234-4800