Provider Demographics
NPI:1578533063
Name:SCHANDORFF, MARK EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:SCHANDORFF
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 1:1045 THOMAS JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4642
Mailing Address - Country:US
Mailing Address - Phone:434-316-6050
Mailing Address - Fax:434-316-6055
Practice Address - Street 1:1045 THOMAS JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4642
Practice Address - Country:US
Practice Address - Phone:434-316-6050
Practice Address - Fax:434-316-6055
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice