Provider Demographics
NPI:1942304571
Name:SCHULTZ, BECKY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11983 INCLINE SHAFT RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9576
Mailing Address - Country:US
Mailing Address - Phone:530-913-9294
Mailing Address - Fax:
Practice Address - Street 1:500 CROWN POINT CIR STE 110
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9514
Practice Address - Country:US
Practice Address - Phone:530-913-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS29467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist