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Individual

DR. EVAN RANDALL SCHMIDT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS,MSD

Contact information

Practice address
3110 WILLOWCREEK RD, PORTAGE, IN 46368-4424
(219) 477-0089
Mailing address
3110 WILLOWCREEK RD, PORTAGE, IN 46368-4424
(219) 477-0089

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12012798A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12012798A
INDIANA DENTAL LICENSE
IN
01
1223X0400X
ORTHODONTICS
IN
01
1420-51-3376
DRIVERS LICENSE NUMBER
IN
Enumeration date
05/27/2019
Last updated
05/27/2019
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