Provider Demographics
NPI:1790197622
Name:GENA SCHULTHEIS DDS LLC
Entity Type:Organization
Organization Name:GENA SCHULTHEIS DDS LLC
Other - Org Name:CALVERT SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-257-7200
Mailing Address - Street 1:10415 SOUTHERN MARYLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-2738
Mailing Address - Country:US
Mailing Address - Phone:410-257-7200
Mailing Address - Fax:
Practice Address - Street 1:10415 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2738
Practice Address - Country:US
Practice Address - Phone:410-257-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty