Provider Demographics
NPI:1518590652
Name:SCHNEIDER, VANESSA (DMD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 LAKESIDE CIR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2147
Mailing Address - Country:US
Mailing Address - Phone:954-982-1688
Mailing Address - Fax:
Practice Address - Street 1:215 LAKESIDE CIR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-2147
Practice Address - Country:US
Practice Address - Phone:954-982-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDRPM2147390200000X
FL26828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty