Provider Demographics
NPI:1003860727
Name:SCHULDT, WILLIAM JACK JR (DDS MS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACK
Last Name:SCHULDT
Suffix:JR
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 WEST SUPERIOR ST
Mailing Address - Street 2:STE 1229
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1711
Mailing Address - Country:US
Mailing Address - Phone:218-722-7404
Mailing Address - Fax:218-722-7404
Practice Address - Street 1:324 WEST SUPERIOR ST
Practice Address - Street 2:STE 1229
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1711
Practice Address - Country:US
Practice Address - Phone:218-722-7404
Practice Address - Fax:218-722-7404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND87541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics