Provider Demographics
NPI:1194813485
Name:SCHULTZ, NIGEL A (DMD)
Entity type:Individual
Prefix:DR
First Name:NIGEL
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:NIGEL
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD PA
Mailing Address - Street 1:3830 S HWY A1A STE 1
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3152
Mailing Address - Country:US
Mailing Address - Phone:321-728-0025
Mailing Address - Fax:321-724-6538
Practice Address - Street 1:3830 S HWY A1A STE 1
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-3152
Practice Address - Country:US
Practice Address - Phone:321-728-0025
Practice Address - Fax:321-724-6538
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20229167Medicaid
FLBS1542073OtherDRUG LIC.