Provider Demographics
NPI:1396872008
Name:SCHMIDT, COLLEEN W (DDS, PA)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:W
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 GRAND PROVINCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1834
Mailing Address - Country:US
Mailing Address - Phone:704-814-6068
Mailing Address - Fax:704-544-8722
Practice Address - Street 1:8035 PROVIDENCE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9716
Practice Address - Country:US
Practice Address - Phone:704-544-1402
Practice Address - Fax:704-544-8722
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice