Healthcare Provider Details

I. General information

NPI: 1083611750
Provider Name (Legal Business Name): ALLEN DUANE SCHULTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

2690 DISPATCH RD
QUINTON VA
23141-1726
US

IV. Provider business mailing address

PO BOX 130
QUINTON VA
23141-0130
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-4940
  • Fax: 804-932-8949
Mailing address:
  • Phone: 804-932-4940
  • Fax: 804-932-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401005309
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: