Healthcare Provider Details

I. General information

NPI: 1912085549
Provider Name (Legal Business Name): LAWRENCE HENRY SCHOONOVER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FRENCH STREET
CLENDENIN WV
25045
US

IV. Provider business mailing address

PO BOX 672
CLENDENIN WV
25045-0672
US

V. Phone/Fax

Practice location:
  • Phone: 304-548-7227
  • Fax: 304-548-7228
Mailing address:
  • Phone: 304-548-7227
  • Fax: 304-548-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2509
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: