Healthcare Provider Details

I. General information

NPI: 1255328068
Provider Name (Legal Business Name): STEVEN JAMES SCHMOLDT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FOREST AVE STE 201
FOND DU LAC WI
54935-4111
US

IV. Provider business mailing address

10 FOREST AVE STE 201
FOND DU LAC WI
54935-4111
US

V. Phone/Fax

Practice location:
  • Phone: 920-933-5332
  • Fax: 920-933-5323
Mailing address:
  • Phone: 920-933-5332
  • Fax: 920-933-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5880-015
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5880-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: