MEDICARE: AUSTIN H SCHMIDT DDS

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	PD0029	AZ

General Provider Information

NPI Number	:	1477162824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN H SCHMIDT DDS

Provider Business Mailing Address
First Line	:	2558 E GARNET AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6204
Country	:	US
Telephone Number	:	515-210-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 W SOUTHERN AVE STE 111
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4307
Country	:	US
Telephone Number	:	602-305-8800
Fax Number	:

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

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	07/30/2020

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