Provider Demographics
NPI:1831268838
Name:SCHMIDTKE, GERARD MATHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:MATHEW
Last Name:SCHMIDTKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:SUITE D
Mailing Address - City:SONOITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85637-0769
Mailing Address - Country:US
Mailing Address - Phone:520-455-5280
Mailing Address - Fax:520-455-5474
Practice Address - Street 1:2220 N CAMINO PRINCIPAL
Practice Address - Street 2:SUITE A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5305
Practice Address - Country:US
Practice Address - Phone:520-885-9977
Practice Address - Fax:520-546-1880
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ41851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice