Provider Demographics
NPI:1558751495
Name:SCHMIDT, WESTON MARK (MDT)
Entity Type:Individual
Prefix:
First Name:WESTON
Middle Name:MARK
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 EAST HOWARD ST.
Mailing Address - Street 2:JACOBSON FAMILY DENTISTRY PC,
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746
Mailing Address - Country:US
Mailing Address - Phone:218-262-3730
Mailing Address - Fax:
Practice Address - Street 1:411 EAST HOWARD ST.
Practice Address - Street 2:JACOBSON FAMILY DENTISTRY PC,
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-262-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT51125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist