Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | M464 | SD |
NPI | 1003033820 |
---|---|
Provider Name | Richard G. Schmid |
First Address | Sturgis, SD 57785-1938 |
Second Address | Sturgis, SD 57785-1938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7801060 | (05) | SD |