Provider Demographics
NPI:1134899842
Name:SCHNEIDER, GARRETT STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:STEVEN
Last Name:SCHNEIDER
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 1:1101 LUDLOW ST APT 1820
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4281
Mailing Address - Country:US
Mailing Address - Phone:718-974-5656
Mailing Address - Fax:
Practice Address - Street 1:12401 ACADEMY RD STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1934
Practice Address - Country:US
Practice Address - Phone:215-632-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist