Provider Demographics
NPI:1851795769
Name:SCHMIDT, DAVID E (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:SCHMIDT
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 1:825 S WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2696
Mailing Address - Country:US
Mailing Address - Phone:847-234-4800
Mailing Address - Fax:847-234-4876
Practice Address - Street 1:825 S WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2696
Practice Address - Country:US
Practice Address - Phone:847-234-4800
Practice Address - Fax:847-234-4876
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-024857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist