Healthcare Provider Details

I. General information

NPI: 1013056720
Provider Name (Legal Business Name): RENEE SCHULTZ-DIETZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12016 PRAIRIE AVE
HEBRON IL
60034-8892
US

IV. Provider business mailing address

12016 PRAIRIE AVE PO BOX 75
HEBRON IL
60034-8892
US

V. Phone/Fax

Practice location:
  • Phone: 815-648-4095
  • Fax: 815-648-2881
Mailing address:
  • Phone: 815-648-4095
  • Fax: 815-648-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: