Provider Demographics
NPI:1487819975
Name:SCHULTZ, BRANDON MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MATTHEW
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 1:1122 S SHASTA AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-8617
Mailing Address - Country:US
Mailing Address - Phone:734-558-6644
Mailing Address - Fax:
Practice Address - Street 1:11160 HWY 62 STE A
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8025
Practice Address - Country:US
Practice Address - Phone:541-826-0599
Practice Address - Fax:541-826-0602
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD91571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice