Provider Demographics
NPI:1003920794
Name:SCHULTZ, JEFFREY D (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
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 1:400 STEVENS ENTRY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4050
Mailing Address - Country:US
Mailing Address - Phone:770-487-3807
Mailing Address - Fax:770-487-1259
Practice Address - Street 1:182A JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5822
Practice Address - Country:US
Practice Address - Phone:770-304-5577
Practice Address - Fax:770-304-5550
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0106481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA19NCBVNMedicare ID - Type Unspecified
GAU41793Medicare UPIN