MEDICARE: SCHNEIDER FAMILY DENTISTRY INC

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	122300000X	Dentist	6535	KS

General Provider Information

NPI Number	:	1124367206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHNEIDER FAMILY DENTISTRY INC

Provider Business Mailing Address
First Line	:	9360 E CENTRAL AVE STE 101
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2560
Country	:	US
Telephone Number	:	316-687-0777
Fax Number	:	316-636-5885

Provider Business Practice Location Address
First Line	:	9360 E CENTRAL AVE STE 101
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2560
Country	:	US
Telephone Number	:	316-687-0777
Fax Number	:	316-636-5885

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK E SCHNEIDER
Credential	:	DMD
Telephone Number	:	316-687-0777

Provider Enumeration Date	:	02/08/2013
Last Update Date	:	02/08/2013

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