Healthcare Provider Details

I. General information

NPI: 1578651865
Provider Name (Legal Business Name): NIGEL SCHULTZ DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/07/2023
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 S HWY A1A STE 1
MELBOURNE BEACH FL
32951-3152
US

IV. Provider business mailing address

3830 S HWY A1A STE 1
MELBOURNE BEACH FL
32951-3152
US

V. Phone/Fax

Practice location:
  • Phone: 321-728-0025
  • Fax: 321-724-6538
Mailing address:
  • Phone: 321-728-0025
  • Fax: 321-724-6538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11691
License Number StateFL

VIII. Authorized Official

Name: DR. NIGEL A SCHULTZ
Title or Position: OWNER PRESIDENT
Credential: DMD
Phone: 321-728-0025