Provider Demographics
NPI:1376738070
Name:SCHNEIDER, MIRIAM D (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:D
Last Name:SCHNEIDER
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 1:18 WILDERNESS LANE
Mailing Address - Street 2:PO BOX 806
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184
Mailing Address - Country:US
Mailing Address - Phone:518-758-6359
Mailing Address - Fax:518-758-9359
Practice Address - Street 1:18 WILDERNESS LANE
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184
Practice Address - Country:US
Practice Address - Phone:518-758-6359
Practice Address - Fax:518-758-9359
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0453881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice