Provider Demographics
NPI:1144221045
Name:SHULER, CARLISS BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLISS
Middle Name:BRUCE
Last Name:SHULER
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 1:2104 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1207
Mailing Address - Country:US
Mailing Address - Phone:160-875-4834
Mailing Address - Fax:
Practice Address - Street 1:2104 GREEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1207
Practice Address - Country:US
Practice Address - Phone:160-875-4834
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40019301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice