Provider Demographics
NPI:1396968129
Name:SCHLEMMER, EDWIN RICHARD (DMD,)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:RICHARD
Last Name:SCHLEMMER
Suffix:
Gender:M
Credentials:DMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824-1636
Mailing Address - Country:US
Mailing Address - Phone:814-265-0300
Mailing Address - Fax:814-265-0551
Practice Address - Street 1:1326 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:PA
Practice Address - Zip Code:15824-1636
Practice Address - Country:US
Practice Address - Phone:814-265-0300
Practice Address - Fax:814-265-0551
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-020275L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005134180001Medicaid
PA037408OtherUNITED CONCORDIA