Provider Demographics
NPI:1083611750
Name:SCHULTZ, ALLEN DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DUANE
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-0130
Mailing Address - Country:US
Mailing Address - Phone:804-932-4940
Mailing Address - Fax:804-932-8949
Practice Address - Street 1:2690 DISPATCH RD
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1726
Practice Address - Country:US
Practice Address - Phone:804-932-4940
Practice Address - Fax:804-932-8949
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
VA04010053091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
545070OtherUNITED CONCORDIA PROVIDER
VA110202OtherANTHEM PROVIDER #