Provider Demographics
NPI:1689403370
Name:SCHMIDT FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:SCHMIDT FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-603-9510
Mailing Address - Street 1:322 ALVOR CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-0069
Mailing Address - Country:US
Mailing Address - Phone:765-603-9510
Mailing Address - Fax:
Practice Address - Street 1:611 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IN
Practice Address - Zip Code:46069-9106
Practice Address - Country:US
Practice Address - Phone:317-758-5334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental