=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053601013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN ELIZABETH SCHULTZ D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2011
-----------------------------------------------------
Last Update Date | 03/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 933 N NORTHWEST HWY 300
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-698-1199
-----------------------------------------------------
Fax | 847-655-6785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 933 N NORTHWEST HWY 300
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-698-1199
-----------------------------------------------------
Fax | 847-655-6785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 019.028709
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------