Provider Demographics
NPI:1629694641
Name:SCHOEN, NATHANIEL THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:THOMAS
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-0128
Mailing Address - Country:US
Mailing Address - Phone:651-565-4647
Mailing Address - Fax:651-565-2899
Practice Address - Street 1:257 MAIN ST W
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1913
Practice Address - Country:US
Practice Address - Phone:651-565-4647
Practice Address - Fax:651-565-2899
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND143811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice