Provider Demographics
NPI:1922352947
Name:SCHMIDT, GARY THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:THOMAS
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 1:6432 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2599
Mailing Address - Country:US
Mailing Address - Phone:714-891-5245
Mailing Address - Fax:714-890-1025
Practice Address - Street 1:6432 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2599
Practice Address - Country:US
Practice Address - Phone:714-891-5245
Practice Address - Fax:714-890-1025
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist