Healthcare Provider Details

I. General information

NPI: 1861462921
Provider Name (Legal Business Name): GARRY ANDREW SCHULTE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

2329 BRIDGEWATER CT
ORANGE PARK FL
32003-8615
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-3441
  • Fax:
Mailing address:
  • Phone: 904-264-7240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM811
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: