Healthcare Provider Details

I. General information

NPI: 1164547188
Provider Name (Legal Business Name): EDWARD ALLEN SCHANDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16040 US HWY 160
FORSYTH MO
65653
US

IV. Provider business mailing address

PO BOX 339
FORSYTH MO
65653
US

V. Phone/Fax

Practice location:
  • Phone: 417-546-2151
  • Fax: 417-546-6866
Mailing address:
  • Phone: 417-546-2151
  • Fax: 417-546-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number011811
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: