=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356971592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUIS WILLIAM SCHMOHL DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2020
-----------------------------------------------------
Last Update Date | 01/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 LARKSPUR LANDING CIR
-----------------------------------------------------
City | LARKSPUR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94939-1757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-459-8006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 FERNWOOD DR
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901-1543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-519-8280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | LL-458-17
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | D21646
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------