Provider Demographics
NPI:1689628000
Name:SCHMID, GREG S (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
Last Name:SCHMID
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 1:14424 N 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3776
Mailing Address - Country:US
Mailing Address - Phone:623-815-0711
Mailing Address - Fax:
Practice Address - Street 1:13470 N 83RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4623
Practice Address - Country:US
Practice Address - Phone:623-776-1376
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice