Provider Demographics
NPI:1497716260
Name:SCHMIDT, CARL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
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 1:62 HART BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2613
Mailing Address - Country:US
Mailing Address - Phone:718-442-3982
Mailing Address - Fax:718-720-3141
Practice Address - Street 1:62 HART BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2613
Practice Address - Country:US
Practice Address - Phone:718-442-3982
Practice Address - Fax:718-720-3141
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030327-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist