Healthcare Provider Details

I. General information

NPI: 1851376990
Provider Name (Legal Business Name): GREGORY LOUIS SCHULTZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 LIBERTY ST
BATH NY
14810-1124
US

IV. Provider business mailing address

209 LIBERTY ST
BATH NY
14810-1124
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-7656
  • Fax: 607-776-7858
Mailing address:
  • Phone: 607-776-7656
  • Fax: 607-776-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0300451
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: