Provider Demographics
NPI:1396724308
Name:SCHNEIDER, BRIAN REX (DDS MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:REX
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:REX
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MD
Mailing Address - Street 1:11030 N TATUM BLVD
Mailing Address - Street 2:SUITE F 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6073
Mailing Address - Country:US
Mailing Address - Phone:602-996-2225
Mailing Address - Fax:602-996-8048
Practice Address - Street 1:11030 N TATUM BLVD
Practice Address - Street 2:SUITE F 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6073
Practice Address - Country:US
Practice Address - Phone:602-996-2225
Practice Address - Fax:602-996-8048
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010173781223S0112X
AZ76291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27 4357491OtherORAL SURGERY