Provider Demographics
NPI:1972581460
Name:SCHULTZ, ROGER W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 DE ZAVALA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2052
Mailing Address - Country:US
Mailing Address - Phone:210-573-3440
Mailing Address - Fax:210-696-3945
Practice Address - Street 1:5015 DE ZAVALA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2052
Practice Address - Country:US
Practice Address - Phone:210-696-9877
Practice Address - Fax:210-696-3945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice