Provider Demographics
NPI:1629237672
Name:SCHMIDT, CHARLES J (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
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 1:22 BUNKER HILL ST
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3009
Mailing Address - Country:US
Mailing Address - Phone:603-788-2517
Mailing Address - Fax:603-788-2520
Practice Address - Street 1:22 BUNKER HILL ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3009
Practice Address - Country:US
Practice Address - Phone:603-788-2517
Practice Address - Fax:603-788-2520
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30306553Medicaid