Healthcare Provider Details

I. General information

NPI: 1659449882
Provider Name (Legal Business Name): GARY R SCHWEEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 FOOTE RD
MEDINA OH
44256-5396
US

IV. Provider business mailing address

5002 FOOTE RD
MEDINA OH
44256-5396
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-8449
  • Fax: 330-722-1805
Mailing address:
  • Phone: 330-725-8449
  • Fax: 330-722-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30-018427
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: