Provider Demographics
NPI:1396757266
Name:SCHOENENBERGER, EDWIN R (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:R
Last Name:SCHOENENBERGER
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 1:2316 N GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1602
Mailing Address - Country:US
Mailing Address - Phone:262-547-1877
Mailing Address - Fax:262-521-3476
Practice Address - Street 1:2316 N GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1602
Practice Address - Country:US
Practice Address - Phone:262-547-1877
Practice Address - Fax:262-521-3476
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics