Provider Demographics
NPI:1255747259
Name:SHULTZ, GEOFFERY D (DDS)
Entity type:Individual
Prefix:DR
First Name:GEOFFERY
Middle Name:D
Last Name:SHULTZ
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 1:201 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5512
Mailing Address - Country:US
Mailing Address - Phone:410-398-0250
Mailing Address - Fax:410-398-9190
Practice Address - Street 1:201 NORTH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5512
Practice Address - Country:US
Practice Address - Phone:410-398-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice