Healthcare Provider Details

I. General information

NPI: 1518963248
Provider Name (Legal Business Name): ROBERT J SCHMIDT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

2043 S OLD HIGHWAY 94
SAINT CHARLES MO
63303-3724
US

IV. Provider business mailing address

141 DOUBLE EAGLE DR
SAINT CHARLES MO
63303-5096
US

V. Phone/Fax

Practice location:
  • Phone: 636-949-0600
  • Fax:
Mailing address:
  • Phone: 636-949-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: