Provider Demographics
NPI:1063480747
Name:SCHMIT, JASON (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SCHMIT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4844
Mailing Address - Country:US
Mailing Address - Phone:319-363-3575
Mailing Address - Fax:319-363-8886
Practice Address - Street 1:2727 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4844
Practice Address - Country:US
Practice Address - Phone:319-363-3575
Practice Address - Fax:319-363-8886
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08823OtherDELTA PROV #
IA0210112Medicaid
IA170454OtherTRICARE PROV #
IA38294OtherWELLMARK PROVIDER #