Provider Demographics
NPI:1114935145
Name:SCHOONOVER, BRAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:SCHOONOVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:BRADLEY
Other - Last Name:SCHOONOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3215 W PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146
Mailing Address - Country:US
Mailing Address - Phone:972-228-0131
Mailing Address - Fax:972-228-0883
Practice Address - Street 1:3215 W PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146
Practice Address - Country:US
Practice Address - Phone:972-228-0131
Practice Address - Fax:972-228-0883
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist