Provider Demographics
NPI:1205848173
Name:SCHMIDT, CARLEEN LINDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLEEN
Middle Name:LINDA
Last Name:SCHMIDT
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 1:2457 N MAYFAIR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1405
Mailing Address - Country:US
Mailing Address - Phone:414-774-7550
Mailing Address - Fax:414-774-3260
Practice Address - Street 1:2457 N MAYFAIR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1405
Practice Address - Country:US
Practice Address - Phone:414-774-7550
Practice Address - Fax:414-774-3260
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3970-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7682Medicaid
WI33682200Medicaid