Healthcare Provider Details

I. General information

NPI: 1790889152
Provider Name (Legal Business Name): RUDY J SCHNEIDER MD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3187 BLUE STEM DR STE 4
WEST FARGO ND
58078-8008
US

IV. Provider business mailing address

1165 S COLUMBIA RD STE C
GRAND FORKS ND
58201-4007
US

V. Phone/Fax

Practice location:
  • Phone: 701-235-7379
  • Fax: 701-235-0977
Mailing address:
  • Phone: 701-772-7379
  • Fax: 701-772-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2211
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: