Provider Demographics
NPI:1851640221
Name:SCHOENER, JASON D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:SCHOENER
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:PSC 94 BOX 2014
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824-0021
Mailing Address - Country:US
Mailing Address - Phone:314-676-8650
Mailing Address - Fax:
Practice Address - Street 1:10397 HALSEY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8210
Practice Address - Country:US
Practice Address - Phone:810-695-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist