Provider Demographics
NPI:1750110722
Name:SCHNEIDER, KARISSA NICHOLE (DMD)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:NICHOLE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:NICHOLE
Other - Last Name:RENYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2200 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-8511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-8511
Practice Address - Country:US
Practice Address - Phone:541-928-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD12045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist