Provider Demographics
NPI:1245660885
Name:SCHONBRUN DENTAL CARE
Entity type:Organization
Organization Name:SCHONBRUN DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHONBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-460-1234
Mailing Address - Street 1:4529 E HONEYGROVE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6087
Mailing Address - Country:US
Mailing Address - Phone:757-460-1234
Mailing Address - Fax:757-464-2524
Practice Address - Street 1:4529 E HONEYGROVE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6087
Practice Address - Country:US
Practice Address - Phone:757-460-1234
Practice Address - Fax:757-464-2524
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4010076111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty