Provider Demographics
NPI:1457318750
Name:SCHWARTZ, JERRY MARSHALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:MARSHALL
Last Name:SCHWARTZ
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 1:6020 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2022
Mailing Address - Country:US
Mailing Address - Phone:915-581-3059
Mailing Address - Fax:
Practice Address - Street 1:128 CHAFFEE RD
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79906-3811
Practice Address - Country:US
Practice Address - Phone:915-568-5001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics