Healthcare Provider Details

I. General information

NPI: 1275984577
Provider Name (Legal Business Name): BRIAN SCHMITZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 ROBIOUS RD STE 130
MIDLOTHIAN VA
23113-5605
US

IV. Provider business mailing address

6900 FOREST AVE SUITE 110
RICHMOND VA
23230-1729
US

V. Phone/Fax

Practice location:
  • Phone: 804-704-8895
  • Fax:
Mailing address:
  • Phone: 804-893-8715
  • Fax: 804-285-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401416026
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: