Healthcare Provider Details

I. General information

NPI: 1235117631
Provider Name (Legal Business Name): MARVIN G. SCHMIDT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 86TH ST 1040 BLDG., #40A
INDIANAPOLIS IN
46240-1868
US

IV. Provider business mailing address

11025 BRIGANTINE DR
INDIANAPOLIS IN
46256-9575
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-6188
  • Fax:
Mailing address:
  • Phone: 317-570-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12005749
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: