MEDICARE: LANCE R. SCHMIDT, DDS, PC

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	5676	OK

General Provider Information

NPI Number	:	1679743751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCE R. SCHMIDT, DDS, PC

Provider Business Mailing Address
First Line	:	10924 HEFNER POINTE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-5061
Country	:	US
Telephone Number	:	405-751-4556
Fax Number	:	405-751-4558

Provider Business Practice Location Address
First Line	:	10924 HEFNER POINTE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-5061
Country	:	US
Telephone Number	:	405-751-4556
Fax Number	:	405-751-4558

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LANCE RYAN SCHMIDT
Credential	:	D.D.S.
Telephone Number	:	405-751-4556

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	06/25/2008

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