Provider Demographics
NPI:1972593960
Name:SCHMIDT, DEBRA KING (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:KING
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 N BLUESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7632
Mailing Address - Country:US
Mailing Address - Phone:316-616-8235
Mailing Address - Fax:
Practice Address - Street 1:4044 N NARRAGANSETT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1586
Practice Address - Country:US
Practice Address - Phone:773-545-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026460122300000X
KS61111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist