Provider Demographics
NPI:1619185295
Name:SCHULTZ, IRVING (DDS)
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:
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 1:1 GREG LANE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5522
Mailing Address - Country:US
Mailing Address - Phone:631-499-4900
Mailing Address - Fax:631-499-3694
Practice Address - Street 1:1 GREG LN
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-5522
Practice Address - Country:US
Practice Address - Phone:631-499-4900
Practice Address - Fax:631-499-3694
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice