Healthcare Provider Details

I. General information

NPI: 1043377310
Provider Name (Legal Business Name): GERALD CHARLES SCHMITZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PREHISTORIC HILL DR
IMPERIAL MO
63052-8026
US

IV. Provider business mailing address

P.O. BOX 1026 1500 PREHISTORIC HILL DR.
IMPERIAL MO
63052-8026
US

V. Phone/Fax

Practice location:
  • Phone: 636-464-2002
  • Fax: 636-464-2003
Mailing address:
  • Phone: 636-464-2002
  • Fax: 636-464-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13968
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: