Provider Demographics
NPI:1265507230
Name:SCHMITT, TERRY J (DDS, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:J
Last Name:SCHMITT
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 RUIN CREEK RD STE 7
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5921
Mailing Address - Country:US
Mailing Address - Phone:252-492-6628
Mailing Address - Fax:252-492-9029
Practice Address - Street 1:568 RUIN CREEK RD STE 7
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5921
Practice Address - Country:US
Practice Address - Phone:252-492-6628
Practice Address - Fax:252-492-9029
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101841223X0400X
IA08111390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14212OtherDELTA DENTAL
IA3234542Medicaid