Provider Demographics
NPI:1255328068
Name:SCHMOLDT, STEVEN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAMES
Last Name:SCHMOLDT
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 1:10 FOREST AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4111
Mailing Address - Country:US
Mailing Address - Phone:920-933-5332
Mailing Address - Fax:920-933-5323
Practice Address - Street 1:10 FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4111
Practice Address - Country:US
Practice Address - Phone:920-933-5332
Practice Address - Fax:920-933-5323
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5880-015122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist