Provider Demographics
NPI:1962825273
Name:JOHN JOHN SCHOENECKER
Entity Type:Organization
Organization Name:JOHN JOHN SCHOENECKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHOENECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DS
Authorized Official - Phone:414-527-4470
Mailing Address - Street 1:9215 W LISBON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2523
Mailing Address - Country:US
Mailing Address - Phone:414-527-4470
Mailing Address - Fax:414-527-4470
Practice Address - Street 1:9215 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2523
Practice Address - Country:US
Practice Address - Phone:414-527-4470
Practice Address - Fax:414-527-4470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR JOHN JOSEPH SCHOENECKER DDS, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40000453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33527000Medicaid