Provider Demographics
NPI:1134919921
Name:GARY W. SHULTS, D.D.S.
Entity type:Organization
Organization Name:GARY W. SHULTS, D.D.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-824-4621
Mailing Address - Street 1:1114 AUSTIN HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4844
Mailing Address - Country:US
Mailing Address - Phone:210-824-4621
Mailing Address - Fax:210-826-7004
Practice Address - Street 1:1114 AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4844
Practice Address - Country:US
Practice Address - Phone:210-824-4621
Practice Address - Fax:210-826-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty