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General NPI Number Information
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NPI Number | 1053656504
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Entity Type | Organization
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Legal Business Name | T.J. SCHOEN FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 257 MAIN ST W
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City | WABASHA
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State | MN
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Zip | 55981-1913
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Country | US
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Telephone | 651-565-4647
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | WABASHA
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State | MN
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Zip | 55981-0128
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Country | US
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Telephone | 651-565-4647
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS JOSEPH SCHOEN
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Credential | DDS
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Telephone | 651-565-4647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9378
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License Number State | MN
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