Provider Demographics
NPI:1447428008
Name:SCHMIEDING DENTAL GROUP
Entity Type:Organization
Organization Name:SCHMIEDING DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHMIEDING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-682-3310
Mailing Address - Street 1:5 SUNRISE LOOP # C
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729
Mailing Address - Country:US
Mailing Address - Phone:406-682-3310
Mailing Address - Fax:406-682-3386
Practice Address - Street 1:5 SUNRISE LOOP # C
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729
Practice Address - Country:US
Practice Address - Phone:406-682-3310
Practice Address - Fax:406-682-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0112863Medicaid
MT1447428008Medicaid
MT5511247OtherBLUE CHIP PROGRAM