Provider Demographics
NPI:1831257294
Name:SCHOONMAKER, RICHARD J (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:SCHOONMAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3114
Mailing Address - Country:US
Mailing Address - Phone:740-773-6159
Mailing Address - Fax:740-773-1078
Practice Address - Street 1:36 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3114
Practice Address - Country:US
Practice Address - Phone:740-773-6159
Practice Address - Fax:740-773-1078
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300197191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0895410Medicaid