Provider Demographics
NPI:1861640591
Name:STEVEN A. SCHMIDT, D.D.S., S.C.
Entity Type:Organization
Organization Name:STEVEN A. SCHMIDT, D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-788-3838
Mailing Address - Street 1:3143 STATE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6964
Mailing Address - Country:US
Mailing Address - Phone:608-788-3838
Mailing Address - Fax:608-788-9862
Practice Address - Street 1:3143 STATE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6964
Practice Address - Country:US
Practice Address - Phone:608-788-3838
Practice Address - Fax:608-788-9862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN A. SCHMIDT, D.D.S., S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31910151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3345600Medicaid