Provider Demographics
NPI:1578651865
Name:NIGEL SCHULTZ DMD PA
Entity Type:Organization
Organization Name:NIGEL SCHULTZ DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-728-0025
Mailing Address - Street 1:3830 S HWY A1A STE 1
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3152
Mailing Address - Country:US
Mailing Address - Phone:321-728-0025
Mailing Address - Fax:321-724-6538
Practice Address - Street 1:3830 S HWY A1A STE 1
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-3152
Practice Address - Country:US
Practice Address - Phone:321-728-0025
Practice Address - Fax:321-724-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20229167Medicaid
FL11691OtherDENTIST LIC
FL11691OtherDENTIST LIC