Provider Demographics
NPI:1316940307
Name:SCHUMM, GREGORY STEPHEN (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:STEPHEN
Last Name:SCHUMM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:SCHUMM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9092 TALBERT AVE
Mailing Address - Street 2:STE 12
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4475
Mailing Address - Country:US
Mailing Address - Phone:714-963-6696
Mailing Address - Fax:
Practice Address - Street 1:9092 TALBERT AVE
Practice Address - Street 2:STE 12
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4475
Practice Address - Country:US
Practice Address - Phone:714-963-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice