Healthcare Provider Details

I. General information

NPI: 1649101437
Provider Name (Legal Business Name): COLIN WADE SCHULTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-7214
US

IV. Provider business mailing address

125 SEGOVIA WAY
LAFAYETTE LA
70506-6792
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-9923
  • Fax:
Mailing address:
  • Phone: 337-981-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7804
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: