Provider Demographics
NPI:1316032139
Name:SCHULTZ, STEVEN W (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
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 1:2000 43RD ST SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8700
Mailing Address - Country:US
Mailing Address - Phone:616-735-2870
Mailing Address - Fax:616-735-2871
Practice Address - Street 1:2140 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4785
Practice Address - Country:US
Practice Address - Phone:616-735-2870
Practice Address - Fax:616-735-2871
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D111530OtherBCBSM
MI143070OtherBCBSD
MI0D111530OtherBCBSM
MICC0861 P00088839Medicare ID - Type UnspecifiedRAILROAD MEDICARE