Provider Demographics
NPI:1326184284
Name:SCHNEIDER, ANDREW LAWRENCE (DDS, PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LAWRENCE
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 HWY 62 65 N STE D
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2005
Mailing Address - Country:US
Mailing Address - Phone:870-741-1577
Mailing Address - Fax:870-741-1648
Practice Address - Street 1:1313 HWY 62 65 N STE D
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2005
Practice Address - Country:US
Practice Address - Phone:870-741-1577
Practice Address - Fax:870-741-1648
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR71-0826745OtherTAX ID