Provider Demographics
NPI:1588825913
Name:RYON G. SCHOFIELD DDS, PC
Entity Type:Organization
Organization Name:RYON G. SCHOFIELD DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYON
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:SCHOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-762-4331
Mailing Address - Street 1:PO BOX 1688
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1688
Mailing Address - Country:US
Mailing Address - Phone:208-762-4331
Mailing Address - Fax:
Practice Address - Street 1:8912 N HESS ST
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9183
Practice Address - Country:US
Practice Address - Phone:208-762-4331
Practice Address - Fax:208-762-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty