Provider Demographics
NPI:1407029960
Name:SCHOENROCK, BRIAN OTTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:OTTO
Last Name:SCHOENROCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 W BUCKHILL RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-8941
Mailing Address - Country:US
Mailing Address - Phone:815-777-0604
Mailing Address - Fax:
Practice Address - Street 1:9600 W BUCKHILL RD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-8941
Practice Address - Country:US
Practice Address - Phone:815-777-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist