Provider Demographics
NPI:1285382986
Name:SCHULTZ DENTAL OFFICE LLC
Entity type:Organization
Organization Name:SCHULTZ DENTAL OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-250-5888
Mailing Address - Street 1:1507 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3345
Mailing Address - Country:US
Mailing Address - Phone:719-250-5888
Mailing Address - Fax:
Practice Address - Street 1:430 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2011
Practice Address - Country:US
Practice Address - Phone:719-542-0036
Practice Address - Fax:719-543-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental