MEDICARE: MARK C SCHMIDT, DDS, LLC

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	20409	MA

General Provider Information

NPI Number	:	1841488384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK C SCHMIDT, DDS, LLC

Provider Business Mailing Address
First Line	:	1156 SPRINGFIELD ST.
Second Line	:
City	:	FEEDING HILLS
State	:	MA
Zip	:	01030-2113
Country	:	US
Telephone Number	:	413-786-4400
Fax Number	:	413-786-4410

Provider Business Practice Location Address
First Line	:	1156 SPRINGFIELD ST.
Second Line	:
City	:	FEEDING HILLS
State	:	MA
Zip	:	01030-2113
Country	:	US
Telephone Number	:	413-786-4400
Fax Number	:	413-786-4410

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK C SCHMIDT
Credential	:	DDS
Telephone Number	:	413-786-4400

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	01/29/2008

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