Provider Demographics
NPI:1649898370
Name:SCHMITZ, MARK JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:SCHMITZ
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 1:1024 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2932
Mailing Address - Country:US
Mailing Address - Phone:812-239-2957
Mailing Address - Fax:
Practice Address - Street 1:1024 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2932
Practice Address - Country:US
Practice Address - Phone:812-645-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013428A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice