Provider Demographics
NPI:1275542466
Name:SCHMIDT, RICHARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
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 1:4709 GOLF RD
Mailing Address - Street 2:SUITE #112
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:847-675-7750
Mailing Address - Fax:
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:SUITE #112
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1231
Practice Address - Country:US
Practice Address - Phone:847-675-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist