Provider Demographics
NPI:1255394698
Name:SCHMIDT, ALAN (DMD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:SCHMIDT
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:PO BOX 971131
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-1131
Mailing Address - Country:US
Mailing Address - Phone:435-653-4333
Mailing Address - Fax:435-635-4331
Practice Address - Street 1:82 S 700 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2462
Practice Address - Country:US
Practice Address - Phone:435-635-4333
Practice Address - Fax:435-635-4331
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12533306-99231223G0001X
PADS0258541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001102800005Medicaid
PA001102800017Medicaid
PA001102800003Medicaid
PA001102800010Medicaid
PA001102800016Medicaid
PA001102800013Medicaid
PA001102800006Medicaid
PA001102800004Medicaid
PA001102800007Medicaid
PA001102800014Medicaid
PA001102800015Medicaid
PA001102800011Medicaid
PA001102800012Medicaid