Provider Demographics
NPI:1477695211
Name:SCHMIDT, ROBERT L (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4500
Mailing Address - Country:US
Mailing Address - Phone:802-773-1020
Mailing Address - Fax:802-773-1024
Practice Address - Street 1:163 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4500
Practice Address - Country:US
Practice Address - Phone:802-773-1020
Practice Address - Fax:802-773-1024
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT21581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011-414Medicaid