Provider Demographics
NPI:1043429558
Name:SCHMIDT, THOMAS CONCANNON (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CONCANNON
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 1:18 THE CHANNEL WAY
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-1217
Mailing Address - Country:US
Mailing Address - Phone:508-896-5083
Mailing Address - Fax:
Practice Address - Street 1:3 W CREEK RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4031
Practice Address - Country:US
Practice Address - Phone:508-825-2289
Practice Address - Fax:508-825-9831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist