MEDICARE: DR. JARED SCOTT SHULTZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	18104	TX

General Provider Information

NPI Number	:	1124023270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED SCOTT SHULTZ DDS

Provider Business Mailing Address
First Line	:	4290 KINSEY DR STE 300
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-1022
Country	:	US
Telephone Number	:	903-630-6868
Fax Number	:	903-630-6871

Provider Business Practice Location Address
First Line	:	4290 KINSEY DR STE 300
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-1022
Country	:	US
Telephone Number	:	903-630-6868
Fax Number	:	903-630-6871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/11/2019

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