Provider Demographics
NPI:1689618779
Name:SCHMUCKER, ALAN R (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:SCHMUCKER
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 1:605 HILLCREST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3680
Mailing Address - Country:US
Mailing Address - Phone:507-451-0290
Mailing Address - Fax:507-451-0291
Practice Address - Street 1:605 HILLCREST AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3680
Practice Address - Country:US
Practice Address - Phone:507-451-0290
Practice Address - Fax:507-451-0291
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND77041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN171398OtherUCARE
MN780218800Medicaid
MN1000370OtherPREFERRED ONE
MN546S4SCOtherBCBS
MN0017438OtherDORAL
MN171398OtherUCARE