Provider Demographics
NPI:1851318513
Name:GARY T. SCHMIDT, DDS, INC.
Entity Type:Organization
Organization Name:GARY T. SCHMIDT, DDS, INC.
Other - Org Name:OLIVE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-891-5245
Mailing Address - Street 1:6432 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2599
Mailing Address - Country:US
Mailing Address - Phone:714-891-5245
Mailing Address - Fax:714-890-1025
Practice Address - Street 1:6432 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2599
Practice Address - Country:US
Practice Address - Phone:714-891-5245
Practice Address - Fax:714-890-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty