Provider Demographics
NPI:1922184779
Name:SCHMITT, MATHEW JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:JOHN
Last Name:SCHMITT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:ROSEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28382
Mailing Address - Country:US
Mailing Address - Phone:910-525-5115
Mailing Address - Fax:910-525-3513
Practice Address - Street 1:401 HWY 24 WEST
Practice Address - Street 2:
Practice Address - City:ROSEBORO
Practice Address - State:NC
Practice Address - Zip Code:28382
Practice Address - Country:US
Practice Address - Phone:910-525-5115
Practice Address - Fax:910-525-3513
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903703Medicaid
NC018JTOtherBCBS