Provider Demographics
NPI:1043377310
Name:SCHMITZ, GERALD CHARLES (DMD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:CHARLES
Last Name:SCHMITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1026
Mailing Address - Street 2:1500 PREHISTORIC HILL DR.
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-8026
Mailing Address - Country:US
Mailing Address - Phone:636-464-2002
Mailing Address - Fax:636-464-2003
Practice Address - Street 1:1500 PREHISTORIC HILL DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-8026
Practice Address - Country:US
Practice Address - Phone:636-464-2002
Practice Address - Fax:636-464-2003
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice