MEDICARE: DR. JOHN M SHULTZ 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	122300000X	Dentist	19811	TX

General Provider Information

NPI Number	:	1538146659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M SHULTZ DDS

Provider Business Mailing Address
First Line	:	1024 S MAIN ST
Second Line	:
City	:	MC GREGOR
State	:	TX
Zip	:	76657-1636
Country	:	US
Telephone Number	:	254-840-2991
Fax Number	:	254-840-9633

Provider Business Practice Location Address
First Line	:	1024 S MAIN ST
Second Line	:
City	:	MC GREGOR
State	:	TX
Zip	:	76657-1636
Country	:	US
Telephone Number	:	254-840-2991
Fax Number	:	254-840-9633

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	06/30/2014

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