Provider Demographics
NPI:1508986068
Name:SCHOENFELDER, BRYAN EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:EDWARD
Last Name:SCHOENFELDER
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 1:1014 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3388
Mailing Address - Country:US
Mailing Address - Phone:605-665-4524
Mailing Address - Fax:
Practice Address - Street 1:1014 W 8TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3388
Practice Address - Country:US
Practice Address - Phone:605-665-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDM860OtherLICENSE