Provider Demographics
NPI:1831685346
Name:SCHNEIDER, JAMES DAVIS (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVIS
Last Name:SCHNEIDER
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 1:6587 GARRISON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527
Mailing Address - Country:US
Mailing Address - Phone:817-995-2949
Mailing Address - Fax:
Practice Address - Street 1:1109 C M FAGAN DR STE P
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5973
Practice Address - Country:US
Practice Address - Phone:985-662-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23631122300000X, 1223G0001X
AL6553122300000X, 1223G0001X
LA70431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist