Provider Demographics
NPI:1134397680
Name:SCENIC DRIVE DENTAL CENTER
Entity type:Organization
Organization Name:SCENIC DRIVE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHMIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-479-5324
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:1171 SCENIC DRIVE
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-0337
Mailing Address - Country:US
Mailing Address - Phone:636-479-5324
Mailing Address - Fax:
Practice Address - Street 1:1171 SCENIC DR
Practice Address - Street 2:
Practice Address - City:HERCULANEUM
Practice Address - State:MO
Practice Address - Zip Code:63048-0337
Practice Address - Country:US
Practice Address - Phone:636-479-5324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty