Provider Demographics
NPI:1598772758
Name:SCHMIDT, MARK C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2113
Mailing Address - Country:US
Mailing Address - Phone:413-786-4400
Mailing Address - Fax:413-786-4410
Practice Address - Street 1:1156 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2113
Practice Address - Country:US
Practice Address - Phone:413-786-4400
Practice Address - Fax:413-786-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice