MEDICARE: DR. GARY MICHAEL SCHULTZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11029	TX

General Provider Information

NPI Number	:	1346243706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY MICHAEL SCHULTZ DDS

Provider Business Mailing Address
First Line	:	301 S HILLSIDE DR
Second Line	:	STE 11
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5324
Country	:	US
Telephone Number	:	361-358-2067
Fax Number	:	361-358-2073

Provider Business Practice Location Address
First Line	:	301 S HILLSIDE DR
Second Line	:	STE 11
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5324
Country	:	US
Telephone Number	:	361-358-2067
Fax Number	:	361-358-2073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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