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General NPI Number Information
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NPI Number | 1205687662
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Entity Type | Individual
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Provider Name | KELLY AMANDA SCHNEIDER DDS
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Gender | Female
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 224 W D. L. INGRAM AVENUE BLDG. 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone | 920-973-8885
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Fax |
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Provider Business Mailing Address
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Address Line | 224 W D. L. INGRAM AVENUE BLDG. 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone |
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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 | 6001492-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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