Provider Demographics
NPI:1225124761
Name:SCHMIDT, BRYAN TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:TIMOTHY
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N FRONT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-1538
Mailing Address - Country:US
Mailing Address - Phone:901-523-8614
Mailing Address - Fax:901-523-0583
Practice Address - Street 1:440 N FRONT ST STE 103
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1538
Practice Address - Country:US
Practice Address - Phone:901-523-8614
Practice Address - Fax:901-523-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 71541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDS7154OtherSTATE LIC.
ARDS3155OtherSTATE LIC.
ARDS3155OtherSTATE LIC.