Kelly Amanda Schneider, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6001492-15 Issued in WI

Practice address

224 W D. L. Ingram Avenue
BLDG. 1408
Cannon Afb, NM 88103

Phone

(920) 973-8885

NPI assigned

Apr 1, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kelly Amanda Herzog Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1205687662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 W D. L. INGRAM AVENUE",
            "address_2": "BLDG. 1408",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "88103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 W D. L. INGRAM AVENUE",
            "address_2": "BLDG. 1408",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "88103",
            "telephone_number": "920-973-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHNEIDER",
        "first_name": "KELLY",
        "middle_name": "AMANDA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-01",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6001492-15",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "HERZOG",
            "middle_name": "AMANDA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Matthew R Rook
• Joketha Faith Ross, RN-BSN
• Danielle Markeeta Sales, DNP, APRN, WHNP-BC
• David A Sarnow, M.D., MPH
• Ray Leroy Schatz III, IDMT
• Richard James Serkowski, DO, MPH, CPE
• June Ellen Shepherd, PH.D.
• Luke Smith, DMD
• Nicholas Kenneth Smythe III, PH.D. IN PROGRESS
• Andrew Springstead

• Dentist in Cannon Afb, NM
• Providers in Cannon Afb, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.