Provider Demographics
NPI:1114015625
Name:SCHNEIDER, MARK E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N SANDPIPER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7013
Mailing Address - Country:US
Mailing Address - Phone:316-686-3589
Mailing Address - Fax:316-636-5885
Practice Address - Street 1:9360 E CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2560
Practice Address - Country:US
Practice Address - Phone:316-687-0777
Practice Address - Fax:316-636-5885
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice