Provider Demographics
NPI:1891705067
Name:SCHULTZ, BRADLEY A (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-5712
Mailing Address - Country:US
Mailing Address - Phone:361-729-3737
Mailing Address - Fax:361-729-7890
Practice Address - Street 1:2827 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-5712
Practice Address - Country:US
Practice Address - Phone:361-729-3737
Practice Address - Fax:361-729-7890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice