Provider Demographics
NPI:1134241581
Name:SCHOENBERG, DAVID GLENN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GLENN
Last Name:SCHOENBERG
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 1:39 WELLESLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1222
Mailing Address - Country:US
Mailing Address - Phone:201-670-0097
Mailing Address - Fax:201-445-0225
Practice Address - Street 1:39 WELLESLEY RD
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1222
Practice Address - Country:US
Practice Address - Phone:201-670-0097
Practice Address - Fax:201-445-0225
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI168071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6882803Medicaid