MEDICARE: DR. TIMOTHY C SCHMIDT DMD

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	DE 60162901	WA
2	122300000X	Dentist	D008539	AZ

General Provider Information

NPI Number	:	1518273143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY C SCHMIDT DMD

Provider Business Mailing Address
First Line	:	4611 E SHEA BLVD STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-4260
Country	:	US
Telephone Number	:	480-786-5484
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 E SHEA BLVD STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-4260
Country	:	US
Telephone Number	:	602-786-5484
Fax Number	:

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

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	11/02/2021

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