Provider Demographics
NPI:1477162824
Name:SCHMIDT, AUSTIN H (DDS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:H
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 1:2558 E GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6204
Mailing Address - Country:US
Mailing Address - Phone:515-210-1775
Mailing Address - Fax:
Practice Address - Street 1:3320 W SOUTHERN AVE STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4307
Practice Address - Country:US
Practice Address - Phone:602-305-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPD00291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice