Provider Demographics
NPI:1639793870
Name:SCHMIDT, BRYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ALVOR CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-0069
Mailing Address - Country:US
Mailing Address - Phone:765-603-9510
Mailing Address - Fax:
Practice Address - Street 1:3901 W STATE ROAD 47 STE 24
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IN
Practice Address - Zip Code:46069-9256
Practice Address - Country:US
Practice Address - Phone:317-758-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013349A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist