Healthcare Provider Details

I. General information

NPI: 1972492460
Provider Name (Legal Business Name): RYAN MACKENZIE SCHULTZ DDS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 2536
SAN FRANCISCO CA
94108-4204
US

IV. Provider business mailing address

875 30TH AVE
SAN FRANCISCO CA
94121-3543
US

V. Phone/Fax

Practice location:
  • Phone: 415-391-5207
  • Fax:
Mailing address:
  • Phone: 949-355-5903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: