Provider Demographics
NPI:1629353768
Name:SCHMIDT, JUSTIN DOUGLASS (DDS #09659)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DOUGLASS
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DDS #09659
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1657
Mailing Address - Country:US
Mailing Address - Phone:541-386-3818
Mailing Address - Fax:
Practice Address - Street 1:1825 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1657
Practice Address - Country:US
Practice Address - Phone:541-386-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice