MEDICARE: SCHULTZ FAMILY DENTISTRY LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1588426613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHULTZ FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	5400 WALSH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2859
Country	:	US
Telephone Number	:	314-353-0900
Fax Number	:	314-353-1018

Provider Business Practice Location Address
First Line	:	5400 WALSH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2859
Country	:	US
Telephone Number	:	314-353-0900
Fax Number	:	314-353-1018

Authorized Official
Title or Position	:	DR./OWNER
Name	:	DR. SCOTT SCHULTZ
Credential	:	DMD
Telephone Number	:	314-353-0900

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	01/24/2024

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