Healthcare Provider Details

I. General information

NPI: 1033168828
Provider Name (Legal Business Name): JAMI M. SCHNEIDER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BRIDGE ST.
PORTLAND MI
48875
US

IV. Provider business mailing address

7820 DAWN DR
PORTLAND MI
48875-1958
US

V. Phone/Fax

Practice location:
  • Phone: 517-647-4511
  • Fax: 517-647-4560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901016738
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: