Provider Demographics
NPI:1578237541
Name:SHULTZ, ERIC (D M D)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1190
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-1190
Mailing Address - Country:US
Mailing Address - Phone:307-367-3700
Mailing Address - Fax:307-312-2848
Practice Address - Street 1:33 FREMONT LAKE RD
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941-5213
Practice Address - Country:US
Practice Address - Phone:307-367-3700
Practice Address - Fax:307-312-2848
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice