Provider Demographics
NPI:1902806532
Name:SCHOONOVER, GARY FRANCIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:FRANCIS
Last Name:SCHOONOVER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 GWINN WAY SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-9498
Mailing Address - Country:US
Mailing Address - Phone:503-316-1817
Mailing Address - Fax:503-390-5931
Practice Address - Street 1:4320 CHERRY AVE NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4855
Practice Address - Country:US
Practice Address - Phone:503-390-2421
Practice Address - Fax:503-390-5931
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-08-31
Provider Licenses
StateLicense IDTaxonomies
OR55241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice