Provider Demographics
NPI:1992931539
Name:SCHULZE, JONATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:SCHULZE
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 1:359 WYCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7146
Mailing Address - Country:US
Mailing Address - Phone:773-680-9148
Mailing Address - Fax:
Practice Address - Street 1:40 BARKSDALE BLVD
Practice Address - Street 2:BARKSDALE AFB
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:71110
Practice Address - Country:US
Practice Address - Phone:773-680-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist