Healthcare Provider Details

I. General information

NPI: 1225243447
Provider Name (Legal Business Name): TERESA N SCHULTZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10662 UNION STAR CHURCH RD
WEST FORK AR
72774-9581
US

IV. Provider business mailing address

10662 UNION STAR CHURCH RD
WEST FORK AR
72774-9581
US

V. Phone/Fax

Practice location:
  • Phone: 479-879-6385
  • Fax: 479-839-4398
Mailing address:
  • Phone: 479-879-6385
  • Fax: 479-839-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4947
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: