Provider Demographics
NPI:1639481062
Name:SCHMIDT, BRANDON L (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:L
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 S SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7106
Mailing Address - Country:US
Mailing Address - Phone:480-236-7835
Mailing Address - Fax:
Practice Address - Street 1:2483 S MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0722
Practice Address - Country:US
Practice Address - Phone:480-857-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist