Provider Demographics
NPI:1417906777
Name:SCHMIDT, BRIAN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 41ST ST FL 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6739
Mailing Address - Country:US
Mailing Address - Phone:212-263-7552
Mailing Address - Fax:212-263-6931
Practice Address - Street 1:222 E 41ST ST FL 22
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6739
Practice Address - Country:US
Practice Address - Phone:212-263-7552
Practice Address - Fax:212-263-6931
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055284-11223S0112X
NY259057204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A633240Medicaid
CAH54968Medicare UPIN
CA00A633240Medicare PIN