Healthcare Provider Details

I. General information

NPI: 1134128192
Provider Name (Legal Business Name): CARL WALTER SCHULTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 RIDGE LAKE BLVD
MEMPHIS TN
38120-9475
US

IV. Provider business mailing address

795 RIDGE LAKE BLVD
MEMPHIS TN
38120-9475
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-5001
  • Fax: 901-682-5099
Mailing address:
  • Phone: 901-682-5001
  • Fax: 901-682-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS3113
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: