Provider Demographics
NPI:1003033820
Name:SCHMID, RICHARD G (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:SCHMID
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 1:1300 JUNCTION AVE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1938
Mailing Address - Country:US
Mailing Address - Phone:605-347-5103
Mailing Address - Fax:605-720-0114
Practice Address - Street 1:1300 JUNCTION AVE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1938
Practice Address - Country:US
Practice Address - Phone:605-347-5103
Practice Address - Fax:605-720-0114
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7801060Medicaid