Provider Demographics
NPI:1508364480
Name:SCHENCK, SYDNI KATE
Entity Type:Individual
Prefix:
First Name:SYDNI
Middle Name:KATE
Last Name:SCHENCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 SAN VISTA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6042
Mailing Address - Country:US
Mailing Address - Phone:785-531-2126
Mailing Address - Fax:
Practice Address - Street 1:7318 SAN VISTA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6042
Practice Address - Country:US
Practice Address - Phone:785-531-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8523-C1124Q00000X
KS12368124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist