Provider Demographics
NPI:1720080591
Name:RICHARD C SCHMIDT
Entity Type:Organization
Organization Name:RICHARD C SCHMIDT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-779-6170
Mailing Address - Street 1:670 SUPERIOR CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6174
Mailing Address - Country:US
Mailing Address - Phone:541-779-6170
Mailing Address - Fax:541-779-0989
Practice Address - Street 1:670 SUPERIOR CT
Practice Address - Street 2:SUITE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6174
Practice Address - Country:US
Practice Address - Phone:541-779-6170
Practice Address - Fax:541-779-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty