Provider Demographics
NPI:1851376990
Name:SCHULTZ, GREGORY LOUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LOUIS
Last Name:SCHULTZ
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 1:209 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1124
Mailing Address - Country:US
Mailing Address - Phone:607-776-7656
Mailing Address - Fax:607-776-7858
Practice Address - Street 1:209 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1124
Practice Address - Country:US
Practice Address - Phone:607-776-7656
Practice Address - Fax:607-776-7858
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0300451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist