Provider Demographics
NPI:1912042086
Name:SCHMIDT, EUGENE J (DDS)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:J
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 1:17928 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5039
Mailing Address - Country:US
Mailing Address - Phone:714-963-8934
Mailing Address - Fax:714-962-7940
Practice Address - Street 1:17928 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5039
Practice Address - Country:US
Practice Address - Phone:714-963-8934
Practice Address - Fax:714-962-7940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWD36281BMedicare ID - Type UnspecifiedPPIN
CAU35252Medicare UPIN