Provider Demographics
NPI:1467449819
Name:SCHMIDT, KEITH ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
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 1:40 YORK RD
Mailing Address - Street 2:STE 220
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5243
Mailing Address - Country:US
Mailing Address - Phone:410-296-6527
Mailing Address - Fax:410-825-4124
Practice Address - Street 1:40 YORK RD
Practice Address - Street 2:STE 220
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5243
Practice Address - Country:US
Practice Address - Phone:410-296-6527
Practice Address - Fax:410-825-4124
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist