Provider Demographics
NPI:1457554149
Name:SCHOENE, GARY ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ROBERT
Last Name:SCHOENE
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 1:1265 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2313
Mailing Address - Country:US
Mailing Address - Phone:716-674-7044
Mailing Address - Fax:716-675-1888
Practice Address - Street 1:1265 CENTER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2313
Practice Address - Country:US
Practice Address - Phone:716-674-7044
Practice Address - Fax:716-675-1888
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0304891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00503668Medicaid