Provider Demographics
NPI:1316316961
Name:DAVID A SCHULTE, DMD, PSC
Entity type:Organization
Organization Name:DAVID A SCHULTE, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN-WHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-345-8281
Mailing Address - Street 1:4515 CHURCHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1172
Mailing Address - Country:US
Mailing Address - Phone:502-361-0637
Mailing Address - Fax:
Practice Address - Street 1:4515 CHURCHMAN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1172
Practice Address - Country:US
Practice Address - Phone:502-361-0637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY85321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100012150Medicaid