Provider Demographics
NPI:1942524640
Name:SCHMIDTKE ORTHODONTICS SC
Entity Type:Organization
Organization Name:SCHMIDTKE ORTHODONTICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:GILPATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:920-731-4451
Mailing Address - Street 1:2900 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1579
Mailing Address - Country:US
Mailing Address - Phone:920-731-4451
Mailing Address - Fax:920-731-2920
Practice Address - Street 1:2900 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1579
Practice Address - Country:US
Practice Address - Phone:920-731-4451
Practice Address - Fax:920-731-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty