Provider Demographics
NPI:1417008525
Name:SCHULTZ, JOANNE CATHERINE (DDS)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:CATHERINE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:CATHERINE ZAUEL
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:85 DONIZETTI ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-4840
Mailing Address - Country:US
Mailing Address - Phone:781-416-9955
Mailing Address - Fax:781-416-9955
Practice Address - Street 1:85 DONIZETTI ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-4840
Practice Address - Country:US
Practice Address - Phone:781-416-9955
Practice Address - Fax:781-416-9955
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163861223G0001X
NH34081223G0001X
OK46291223G0001X
MI107311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0269603Medicaid
NH30302783Medicaid