Provider Demographics
NPI:1194607119
Name:SCHULTZ, MINA (DMD)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 FOREST DR APT 254
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-3174
Mailing Address - Country:US
Mailing Address - Phone:404-989-9144
Mailing Address - Fax:
Practice Address - Street 1:4547 HARD SCRABBLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8561
Practice Address - Country:US
Practice Address - Phone:803-788-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC112001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice