Provider Demographics
NPI:1700933082
Name:SCHMUCKLER, ELLIOTT NEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:NEIL
Last Name:SCHMUCKLER
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 1:3501 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073
Mailing Address - Country:US
Mailing Address - Phone:610-355-2400
Mailing Address - Fax:
Practice Address - Street 1:3501 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073
Practice Address - Country:US
Practice Address - Phone:610-355-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023158L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist