Provider Demographics
NPI:1013368695
Name:SCHMIDT, MEGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 ROOSEVELT RD STE B
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2746
Mailing Address - Country:US
Mailing Address - Phone:219-531-9293
Mailing Address - Fax:219-654-2842
Practice Address - Street 1:2005 ROOSEVELT RD STE B
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2746
Practice Address - Country:US
Practice Address - Phone:219-531-9293
Practice Address - Fax:219-654-2842
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030770122300000X
IN12012654A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist