Healthcare Provider Details

I. General information

NPI: 1003090630
Provider Name (Legal Business Name): JUDITH K. SCHMIDT, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
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: 701-672-9595
  • Fax: 701-672-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1995
License Number StateND

VIII. Authorized Official

Name: DR. JUDITH K SCHMIDT
Title or Position: PRESIDENT
Credential: DDS
Phone: 701-672-9595