Provider Demographics
NPI:1265650691
Name:SCHMIDT, ROBERT WILLIAM (DDS, FAGD PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DDS, FAGD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E NORRIS DR
Mailing Address - Street 2:P O BOX 129
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1518
Mailing Address - Country:US
Mailing Address - Phone:815-434-1688
Mailing Address - Fax:815-434-1690
Practice Address - Street 1:333 E NORRIS DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1518
Practice Address - Country:US
Practice Address - Phone:815-434-1688
Practice Address - Fax:815-434-1690
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice