Provider Demographics
NPI:1972492460
Name:SCHULTZ, RYAN MACKENZIE (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MACKENZIE
Last Name:SCHULTZ
Suffix:
Gender:X
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3543
Mailing Address - Country:US
Mailing Address - Phone:949-355-5903
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 2536
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4204
Practice Address - Country:US
Practice Address - Phone:415-391-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1118591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice