Provider Demographics
NPI:1235117631
Name:SCHMIDT, MARVIN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:G
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 1:11025 BRIGANTINE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9575
Mailing Address - Country:US
Mailing Address - Phone:317-570-9613
Mailing Address - Fax:
Practice Address - Street 1:1010 E 86TH ST
Practice Address - Street 2:1040 BLDG., #40A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1868
Practice Address - Country:US
Practice Address - Phone:317-846-6188
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120057491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice