Provider Demographics
NPI:1154992857
Name:SCHICKTANZ, TONY SPINDLER (DDS)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:SPINDLER
Last Name:SCHICKTANZ
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 1:6400 CENTRAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-2033
Mailing Address - Country:US
Mailing Address - Phone:505-375-6175
Mailing Address - Fax:
Practice Address - Street 1:6400 CENTRAL AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-2033
Practice Address - Country:US
Practice Address - Phone:505-375-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD54661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice