Provider Demographics
NPI:1275062465
Name:SCHMIDT, AMBER (DMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18551 E MAINSTREET STE 1C
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4951
Mailing Address - Country:US
Mailing Address - Phone:813-298-6559
Mailing Address - Fax:
Practice Address - Street 1:18551 E MAINSTREET STE 1C
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4951
Practice Address - Country:US
Practice Address - Phone:720-851-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330041223G0001X
CO00204176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice