Provider Demographics
NPI:1285694547
Name:SCHOENSTEIN, MELVIN ELWOOD (DDS)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:ELWOOD
Last Name:SCHOENSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15644 MADISON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5622
Mailing Address - Country:US
Mailing Address - Phone:216-521-8380
Mailing Address - Fax:
Practice Address - Street 1:15644 MADISON AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5622
Practice Address - Country:US
Practice Address - Phone:216-521-8380
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30014249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0261247Medicaid