Provider Demographics
NPI:1003830712
Name:SCHULTE, JOHN KEITH (DDS,MSD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEITH
Last Name:SCHULTE
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 COPE AVE E
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2662
Mailing Address - Country:US
Mailing Address - Phone:651-770-1612
Mailing Address - Fax:651-748-3704
Practice Address - Street 1:1774 COPE AVE E
Practice Address - Street 2:SUITE 140
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2662
Practice Address - Country:US
Practice Address - Phone:651-770-1612
Practice Address - Fax:651-748-3704
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86021223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics