MEDICARE: DR. OTIS D. SCHULTHEIS 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	9338	MN

General Provider Information

NPI Number	:	1982784377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OTIS D. SCHULTHEIS DDS

Provider Business Mailing Address
First Line	:	14061 SAINT FRANCIS BLVD
Second Line	:
City	:	RAMSEY
State	:	MN
Zip	:	55303-4692
Country	:	US
Telephone Number	:	763-576-1855
Fax Number	:	763-421-0519

Provider Business Practice Location Address
First Line	:	14061 SAINT FRANCIS BLVD
Second Line	:
City	:	RAMSEY
State	:	MN
Zip	:	55303-4692
Country	:	US
Telephone Number	:	763-576-1855
Fax Number	:	763-421-0519

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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