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General NPI Number Information
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NPI Number | 1982263893
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Entity Type | Organization
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Legal Business Name | SCHMIDT DENTAL HOLDINGS LLC
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 7430 W FOREST HOME AVE
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City | GREENFIELD
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State | WI
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Zip | 53220-3358
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Country | US
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Telephone | 414-543-2500
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Fax |
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Provider Business Mailing Address
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Address Line | W266S3365 HAWTHORNE HOLLOW DR
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City | WAUKESHA
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State | WI
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Zip | 53189-6218
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Country | US
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Telephone | 262-490-0831
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEREK T SCHMIDT
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Credential | DDS
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Telephone | 262-490-0831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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