Provider Demographics
NPI:1912014697
Name:SCHMIDT, JOSEPH MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARK
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-547-8665
Mailing Address - Fax:262-547-4328
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-547-8665
Practice Address - Fax:262-547-4328
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI39681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33699100Medicaid
WI33699100Medicaid