Provider Demographics
NPI:1699898262
Name:CHARLES W. SCHMIDT DDS, PA
Entity type:Organization
Organization Name:CHARLES W. SCHMIDT DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-365-1717
Mailing Address - Street 1:3300 SW 34TH AVE STE 136
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4438
Mailing Address - Country:US
Mailing Address - Phone:352-873-4844
Mailing Address - Fax:352-873-8408
Practice Address - Street 1:3300 SW 34TH AVE STE 136
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4438
Practice Address - Country:US
Practice Address - Phone:352-873-4844
Practice Address - Fax:352-873-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN131921223G0001X
FLDN55431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty