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NPI 1972581460

NPI 1972581460 : ROGER W. SCHULTZ DDS : SAN ANTONIO, TX

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General NPI Number Information
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    NPI Number           |    1972581460
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    Entity Type          |    Individual 
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    Provider Name        |    ROGER W. SCHULTZ DDS
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    01/04/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    5015 DE ZAVALA RD SUITE 104
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    City                 |    SAN ANTONIO
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    State                |    TX
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    Zip                  |    78249-2052
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    Country              |    US
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    Telephone            |    210-696-9877
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    Fax                  |    210-696-3945
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Provider Business Mailing Address
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    Address Line         |    5015 DE ZAVALA RD SUITE 104
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    City                 |    SAN ANTONIO
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    State                |    TX
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    Zip                  |    78249-2052
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    Country              |    US
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    Telephone            |    210-573-3440
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    Fax                  |    210-696-3945
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    19766
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    License Number State |    TX
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