Healthcare Provider Details

I. General information

NPI: 1801899745
Provider Name (Legal Business Name): H JOHN SCHUTZE II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

453 DIXON RD STE 3
QUEENSBURY NY
12804-1964
US

IV. Provider business mailing address

453 DIXON RD STE 3
QUEENSBURY NY
12804-1964
US

V. Phone/Fax

Practice location:
  • Phone: 518-793-3553
  • Fax: 518-793-5695
Mailing address:
  • Phone: 518-793-3553
  • Fax: 518-793-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: