Provider Demographics
NPI:1023199775
Name:MABEL B SCHNEIDER-UTZ D D S A PROFFESSIONAL CORP.
Entity Type:Organization
Organization Name:MABEL B SCHNEIDER-UTZ D D S A PROFFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:BEATRIZ
Authorized Official - Last Name:SCHNEIDER-UTZ
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:626-333-8166
Mailing Address - Street 1:864 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-2847
Mailing Address - Country:US
Mailing Address - Phone:626-333-8166
Mailing Address - Fax:626-333-9879
Practice Address - Street 1:864 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-2847
Practice Address - Country:US
Practice Address - Phone:626-333-8166
Practice Address - Fax:626-333-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty