Provider Demographics
NPI:1124084389
Name:SCHULENBERG, GILBERT HAROLD (DDS)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:HAROLD
Last Name:SCHULENBERG
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 1:117 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2003
Mailing Address - Country:US
Mailing Address - Phone:716-882-6333
Mailing Address - Fax:716-882-0891
Practice Address - Street 1:117 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2003
Practice Address - Country:US
Practice Address - Phone:716-882-6333
Practice Address - Fax:716-882-0891
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0344621223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00760352Medicaid
NY00760352Medicaid