Provider Demographics
NPI:1922375450
Name:SCHMIDT/FAITH ORTHODONTICS LLC
Entity Type:Organization
Organization Name:SCHMIDT/FAITH ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-854-1873
Mailing Address - Street 1:1700 E ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9632
Mailing Address - Country:US
Mailing Address - Phone:847-854-1873
Mailing Address - Fax:847-854-3975
Practice Address - Street 1:1700 E ALGONQUIN RD
Practice Address - Street 2:STE 216
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9632
Practice Address - Country:US
Practice Address - Phone:847-854-1873
Practice Address - Fax:847-854-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL248000457302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization