Provider Demographics
NPI:1316160203
Name:SCHNEIDER, MICHAEL B (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
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 1:381 HOPMEADOW ST.
Mailing Address - Street 2:P.O. BOX 323
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-0323
Mailing Address - Country:US
Mailing Address - Phone:860-651-3781
Mailing Address - Fax:
Practice Address - Street 1:381 HOPMEADOW ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9692
Practice Address - Country:US
Practice Address - Phone:860-651-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist