Healthcare Provider Details

I. General information

NPI: 1164833497
Provider Name (Legal Business Name): JOHN CHARLES SCHLOTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MEDICAL GROUP UNIT 5210; BUILDING #944
APO AE
09461
US

IV. Provider business mailing address

48TH MDG UNIT 5115
APO AE
09461-5115
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8813
  • Fax:
Mailing address:
  • Phone: 314-226-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2014017257
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: