1255394698 NPI number — ALAN SCHMIDT DMD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255394698 NPI number — ALAN SCHMIDT DMD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SCHMIDT

Provider First Name:

ALAN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DMD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1255394698

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/12/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 971131

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

OREM

Provider Business Mailing Address State Name:

UT

Provider Business Mailing Address Postal Code:

84097-1131

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

435-653-4333

Provider Business Mailing Address Fax Number:

435-635-4331

Provider First Line Business Practice Location Address:

82 S 700 W

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HURRICANE

Provider Business Practice Location Address State Name:

UT

Provider Business Practice Location Address Postal Code:

84737-2462

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

435-635-4333

Provider Business Practice Location Address Fax Number:

435-635-4331

Provider Enumeration Date:

04/07/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1223G0001X , with the licence number:  12533306-9923 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 1223G0001X , with the licence number: DS025854 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 001102800005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 001102800012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".