Healthcare Provider Details

I. General information

NPI: 1083720114
Provider Name (Legal Business Name): JUDITH KAY SCHMIDT D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 WOODLAND DRIVE
WAHPETON ND
58075
US

IV. Provider business mailing address

PO BOX 36
WAHPETON ND
58074-0036
US

V. Phone/Fax

Practice location:
  • Phone: 701-672-9595
  • Fax: 701-672-9599
Mailing address:
  • Phone: 701-640-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1995
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12309
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: