Provider Demographics
NPI:1154483980
Name:SCHULLER, JAMES P (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:SCHULLER
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 1:1000 42ND ST SE
Mailing Address - Street 2:1000 PROFESSIONAL CENTRE SUITE B
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403
Mailing Address - Country:US
Mailing Address - Phone:319-362-0043
Mailing Address - Fax:319-362-1018
Practice Address - Street 1:1000 42ND ST SE
Practice Address - Street 2:1000 PROFESSIONAL CENTRE SUITE B
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403
Practice Address - Country:US
Practice Address - Phone:319-362-0043
Practice Address - Fax:319-362-1018
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0237875Medicaid