Provider Demographics
NPI:1053743120
Name:SCHMIDT, STEVEN ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLAN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 STATE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6964
Mailing Address - Country:US
Mailing Address - Phone:608-788-3838
Mailing Address - Fax:608-788-9862
Practice Address - Street 1:3143 STATE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6964
Practice Address - Country:US
Practice Address - Phone:608-788-3838
Practice Address - Fax:608-788-9862
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3191-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3345600Medicaid