Provider Demographics
NPI:1467882654
Name:DR. MICHAEL W. SCHULTE
Entity Type:Organization
Organization Name:DR. MICHAEL W. SCHULTE
Other - Org Name:STAFFORD SMILES COSMETIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTISIT /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-659-6650
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:623 GARRISONVILLE ROAD
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-0279
Mailing Address - Country:US
Mailing Address - Phone:540-659-6650
Mailing Address - Fax:540-657-0576
Practice Address - Street 1:623 GARRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3710
Practice Address - Country:US
Practice Address - Phone:540-659-6650
Practice Address - Fax:540-657-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005624261QD0000X
VA040413627261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982611182Medicaid
VA1306193461Medicaid