MEDICARE: GARY T. SCHMIDT, DDS, INC.

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	25027	CA

General Provider Information

NPI Number	:	1851318513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY T. SCHMIDT, DDS, INC.

Provider Business Mailing Address
First Line	:	6432 BOLSA AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2599
Country	:	US
Telephone Number	:	714-891-5245
Fax Number	:	714-890-1025

Provider Business Practice Location Address
First Line	:	6432 BOLSA AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2599
Country	:	US
Telephone Number	:	714-891-5245
Fax Number	:	714-890-1025

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARY THOMAS SCHMIDT
Credential	:	DDS
Telephone Number	:	714-891-5245

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/29/2012

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