Provider Demographics
NPI:1174662365
Name:SCHEIDERICH, MARK DAVID (DMD PA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:SCHEIDERICH
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CANE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9707
Mailing Address - Country:US
Mailing Address - Phone:828-684-5888
Mailing Address - Fax:828-684-1093
Practice Address - Street 1:20 CANE CREEK RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9707
Practice Address - Country:US
Practice Address - Phone:828-684-5888
Practice Address - Fax:828-684-1093
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC80281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice