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NPI 1104174382

NPI 1104174382 : ZACHARY SCHMIDT DDS : IRON RIVER, WI

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General NPI Number Information
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    NPI Number           |    1104174382
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    Entity Type          |    Individual 
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    Provider Name        |    ZACHARY SCHMIDT DDS
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    08/21/2012
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    Last Update Date     |    08/21/2012
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Provider Practice Location Address
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    Address Line         |    7665 US HIGHWAY 2 
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    City                 |    IRON RIVER
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    State                |    WI
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    Zip                  |    54847-4690
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    Country              |    US
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    Telephone            |    715-372-5001
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    822 9TH AVE W 
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    City                 |    ASHLAND
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    State                |    WI
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    Zip                  |    54806-2812
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    Country              |    US
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    Telephone            |    715-415-7259
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    6975
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    License Number State |    WI
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