Provider Demographics
NPI:1790889152
Name:SCHNEIDER, RUDY J (MD DDS)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:J
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1165 S COLUMBIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4007
Mailing Address - Country:US
Mailing Address - Phone:701-772-7379
Mailing Address - Fax:701-772-9643
Practice Address - Street 1:3187 BLUE STEM DR STE 4
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8008
Practice Address - Country:US
Practice Address - Phone:701-235-7379
Practice Address - Fax:701-235-0977
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND22111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14082Medicaid
ND40154Medicaid
I00570Medicare UPIN