Provider Demographics
NPI:1003090630
Name:JUDITH K. SCHMIDT, D.D.S., P.C.
Entity Type:Organization
Organization Name:JUDITH K. SCHMIDT, D.D.S., P.C.
Other - Org Name:THE CLINIC FOR ORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-672-9595
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58074-0036
Mailing Address - Country:US
Mailing Address - Phone:701-672-9595
Mailing Address - Fax:701-672-9599
Practice Address - Street 1:2005 WOODLAND DRIVE
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075
Practice Address - Country:US
Practice Address - Phone:701-672-9595
Practice Address - Fax:701-672-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
ND1995261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1465636Medicaid