Provider Demographics
NPI:1821606948
Name:SCHOFIELD, BRYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:SCHOFIELD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N LOCUST GROVE RD UNIT 50B
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8270
Mailing Address - Country:US
Mailing Address - Phone:503-580-0616
Mailing Address - Fax:
Practice Address - Street 1:9201 SE 91ST AVE STE 140
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-3760
Practice Address - Country:US
Practice Address - Phone:503-253-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-5183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist