Provider Demographics
NPI:1962978551
Name:SCHWARTZ, CANDICE CARLY (BDS, MBA)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:CARLY
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:BDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78532 POMPEII CT
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7922
Mailing Address - Country:US
Mailing Address - Phone:720-546-3481
Mailing Address - Fax:
Practice Address - Street 1:42900 BOB HOPE DR STE 111
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4442
Practice Address - Country:US
Practice Address - Phone:760-565-6055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT5739868OtherCA DRIVERS LICENSE