Provider Demographics
NPI:1083928360
Name:SCHWARTZ, MICOLE NEIMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICOLE
Middle Name:NEIMAN
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 CEDAR SPRINGS RD APT A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-6634
Mailing Address - Country:US
Mailing Address - Phone:214-252-9059
Mailing Address - Fax:
Practice Address - Street 1:3405 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2737
Practice Address - Country:US
Practice Address - Phone:972-350-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice