MEDICARE: JAMI M. SCHNEIDER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901016738	MI

General Provider Information

NPI Number	:	1033168828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMI M. SCHNEIDER D.D.S.

Provider Business Mailing Address
First Line	:	7820 DAWN DR
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1958
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 BRIDGE ST.
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875
Country	:	US
Telephone Number	:	517-647-4511
Fax Number	:	517-647-4560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/08/2007

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