Provider Demographics
NPI:1720155229
Name:SCHMITZ, TROY A (DDS)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
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 1:2385 TROOP DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377
Mailing Address - Country:US
Mailing Address - Phone:320-251-2972
Mailing Address - Fax:320-255-5514
Practice Address - Street 1:2385 TROOP DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377
Practice Address - Country:US
Practice Address - Phone:320-251-2972
Practice Address - Fax:320-255-5514
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN63222100OtherMEDICAL ASSISTANCE
MN6B286SCOtherBCBS