=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376245035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FREDRICK WESLEY SCHOENTHAL V
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2023
-----------------------------------------------------
Last Update Date | 09/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1243 AUGUSTA WEST PKWY
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30909-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-477-6138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1243 AUGUSTA WEST PKWY
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30909-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-477-6138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DN123744
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------