Healthcare Provider Details

I. General information

NPI: 1831412956
Provider Name (Legal Business Name): GILPATRICK SCHMIDTKE D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MEADE ST
APPLETON WI
54911-1579
US

IV. Provider business mailing address

2900 N MEADE ST
APPLETON WI
54911-1579
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-4451
  • Fax: 920-731-2920
Mailing address:
  • Phone: 920-731-4451
  • Fax: 920-731-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4974
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: