Healthcare Provider Details

I. General information

NPI: 1164546503
Provider Name (Legal Business Name): SIDNEY B. SCHULZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH 275 MILITARY RD.
SHERWOOD WI
54169-0159
US

IV. Provider business mailing address

NORTH 275 MILITARY RD.
SHERWOOD WI
54169-0159
US

V. Phone/Fax

Practice location:
  • Phone: 920-989-1103
  • Fax: 920-989-1102
Mailing address:
  • Phone: 920-989-1103
  • Fax: 920-989-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3822-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: