Provider Demographics
NPI:1346243706
Name:SCHULTZ, GARY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:SCHULTZ
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 1:301 S HILLSIDE DR
Mailing Address - Street 2:STE 11
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5324
Mailing Address - Country:US
Mailing Address - Phone:361-358-2067
Mailing Address - Fax:361-358-2073
Practice Address - Street 1:301 S HILLSIDE DR
Practice Address - Street 2:STE 11
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5324
Practice Address - Country:US
Practice Address - Phone:361-358-2067
Practice Address - Fax:361-358-2073
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice