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NPI Code Detail

MEDICARE: WILLIAM J. SCHULDT, D.D.S., P.A.

MEDICARE: WILLIAM J. SCHULDT, D.D.S., P.A.
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
11223P0300XPeriodonticsD8754MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17B051SCOTHERMNBCBS PROVIDER
21003860727OTHERMNNPI INDIVIDUAL
32448391OTHERMNVA
47B050SCOTHERMNBCBS CLINIC
5407230OTHERMNUNITED CONCORDIA

General Provider Information

NPI Number : 1922145861
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLIAM J. SCHULDT, D.D.S., P.A.
Provider Business Mailing Address
First Line : 324 W SUPERIOR ST
Second Line : SUITE 1229
City : DULUTH
State : MN
Zip : 55802-1701
Country : US
Telephone Number : 218-722-7404
Fax Number :
Provider Business Practice Location Address
First Line : 324 W SUPERIOR ST
Second Line : SUITE 1229
City : DULUTH
State : MN
Zip : 55802-1701
Country : US
Telephone Number : 218-722-7404
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM JACK SCHULDT JR.
Credential : D.D.S., M.S.
Telephone Number : 218-722-7404
Provider Enumeration Date : 01/31/2007
Last Update Date : 03/07/2023

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