Provider Demographics
NPI:1881061968
Name:GEORGE A SCHNEIDER
Entity type:Organization
Organization Name:GEORGE A SCHNEIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-542-4692
Mailing Address - Street 1:1432 TOWNVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7538
Mailing Address - Country:US
Mailing Address - Phone:707-542-4692
Mailing Address - Fax:707-542-4698
Practice Address - Street 1:1432 TOWNVIEW LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7538
Practice Address - Country:US
Practice Address - Phone:707-542-4692
Practice Address - Fax:707-542-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30552261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental