Healthcare Provider Details

I. General information

NPI: 1114997533
Provider Name (Legal Business Name): ROBERT WILLIAM SCHUTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 ADMIRAL TAUSSIG BLVD
NORFOLK VA
23511-2803
US

IV. Provider business mailing address

104 DAWN PL
YORKTOWN VA
23693-3628
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-6500
  • Fax:
Mailing address:
  • Phone: 757-867-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0401007031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: