Healthcare Provider Details

I. General information

NPI: 1477599785
Provider Name (Legal Business Name): DR. ANDREW XAVIER SCHMID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5053 MAIN STREET
MANCHESTER CTR VT
05255
US

IV. Provider business mailing address

PO BOX 2509
MANCHESTER CENTER VT
05255-2509
US

V. Phone/Fax

Practice location:
  • Phone: 802-362-2345
  • Fax:
Mailing address:
  • Phone: 802-362-2345
  • Fax: 802-362-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2098
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: