Provider Demographics
NPI:1255544565
Name:CHARLES W. SCHMIDT DDS, PA
Entity type:Organization
Organization Name:CHARLES W. SCHMIDT DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-365-1717
Mailing Address - Street 1:1640 S CONGRESS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2125
Mailing Address - Country:US
Mailing Address - Phone:561-439-7550
Mailing Address - Fax:561-439-0782
Practice Address - Street 1:1640 S CONGRESS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-2125
Practice Address - Country:US
Practice Address - Phone:561-439-7550
Practice Address - Fax:561-439-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty