Provider Demographics
NPI:1376760181
Name:SCHULZ, SCOTT O (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:O
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4952 SKYVIEW CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6970
Mailing Address - Country:US
Mailing Address - Phone:231-929-3200
Mailing Address - Fax:231-932-7569
Practice Address - Street 1:4952 SKYVIEW CT
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6970
Practice Address - Country:US
Practice Address - Phone:231-929-3200
Practice Address - Fax:231-932-7569
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010170151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics