Provider Demographics
NPI:1255790580
Name:SCHNEIDER, CARLY (CAROL) (RDH; COM)
Entity type:Individual
Prefix:
First Name:CARLY (CAROL)
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:RDH; COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 LOMITA DRIVE
Mailing Address - Street 2:SUIT D
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-888-8691
Mailing Address - Fax:415-888-8691
Practice Address - Street 1:147 LOMITA DR
Practice Address - Street 2:SUIT D
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1451
Practice Address - Country:US
Practice Address - Phone:415-888-8691
Practice Address - Fax:415-888-8691
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10169124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist