Provider Demographics
NPI:1083106694
Name:SCHUT AND ASSOCIATES 1, PLLC
Entity Type:Organization
Organization Name:SCHUT AND ASSOCIATES 1, PLLC
Other - Org Name:WHITEVILLE FAMILY AND COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHUT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-327-2248
Mailing Address - Street 1:102 BRETONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4002
Mailing Address - Country:US
Mailing Address - Phone:910-859-9883
Mailing Address - Fax:
Practice Address - Street 1:904 SPIVEY RD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472
Practice Address - Country:US
Practice Address - Phone:910-642-7741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497162838OtherTYPE II NPI
NC18881842656OtherTYPE 1 NPI