Provider Demographics
NPI:1700845674
Name:SCHILT, JOHN C (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:SCHILT
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 1:244 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4602
Mailing Address - Country:US
Mailing Address - Phone:541-736-0044
Mailing Address - Fax:541-654-4552
Practice Address - Street 1:244 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4602
Practice Address - Country:US
Practice Address - Phone:541-736-0044
Practice Address - Fax:541-654-4552
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR77311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice