Provider Demographics
NPI:1265576649
Name:SCHNECK, KARL EDWIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:EDWIN
Last Name:SCHNECK
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 1:1094 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6138
Mailing Address - Country:US
Mailing Address - Phone:541-779-4344
Mailing Address - Fax:541-776-9849
Practice Address - Street 1:1094 ROYAL CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6138
Practice Address - Country:US
Practice Address - Phone:541-779-4344
Practice Address - Fax:541-776-9849
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD9239OtherDENTAL