=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801903901
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES TODD SCHULTZ DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26206 WEST TWELVE MILE ROAD STE 104
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-827-1220
-----------------------------------------------------
Fax | 248-827-8180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26206 WEST TWELVE MILE ROAD STE 104
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-827-1220
-----------------------------------------------------
Fax | 248-827-8180
-----------------------------------------------------
=====================================================
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 | 2901013266
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------