Provider Demographics
NPI:1477661445
Name:SCHMITT, STACY MAURICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:MAURICE
Last Name:SCHMITT
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 1:3400 LOMA VISTA RD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3033
Mailing Address - Country:US
Mailing Address - Phone:805-642-6884
Mailing Address - Fax:805-642-3135
Practice Address - Street 1:3400 LOMA VISTA RD
Practice Address - Street 2:SUITE #8
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3033
Practice Address - Country:US
Practice Address - Phone:805-642-6884
Practice Address - Fax:805-642-3135
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist