Provider Demographics
NPI:1194470815
Name:SCHMIDT, NATALIE MODLY (DMD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MODLY
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 MERCHANT CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8486
Mailing Address - Country:US
Mailing Address - Phone:941-907-7762
Mailing Address - Fax:
Practice Address - Street 1:7307 MERCHANT CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8486
Practice Address - Country:US
Practice Address - Phone:941-907-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN271011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty