MEDICARE: MARK JOSEPH SCHMITZ 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	12013428A	IN

General Provider Information

NPI Number	:	1649898370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JOSEPH SCHMITZ DDS

Provider Business Mailing Address
First Line	:	1024 LAFAYETTE AVE
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-2932
Country	:	US
Telephone Number	:	812-239-2957
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 LAFAYETTE AVE
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-2932
Country	:	US
Telephone Number	:	812-645-2248
Fax Number	:

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

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	07/09/2020

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