Provider Demographics
NPI:1417989112
Name:SCHOEN, SCOTT ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:SCHOEN
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 1:5400 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-2002
Mailing Address - Country:US
Mailing Address - Phone:501-225-8929
Mailing Address - Fax:501-225-0334
Practice Address - Street 1:5400 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-2002
Practice Address - Country:US
Practice Address - Phone:501-225-8929
Practice Address - Fax:501-225-0334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR29991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58602Medicare ID - Type Unspecified
ARU41616Medicare UPIN