Provider Demographics
NPI:1609839166
Name:SCHOLTZ, MICHAEL LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:SCHOLTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6251
Mailing Address - Country:US
Mailing Address - Phone:410-562-2820
Mailing Address - Fax:252-737-7049
Practice Address - Street 1:1851 MACGREGOR DOWNS RD
Practice Address - Street 2:EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-737-7029
Practice Address - Fax:252-737-7041
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8903019Medicaid