Provider Demographics
NPI:1275047946
Name:SCHULTZ, NICHOLAS CHRISTIAN (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHRISTIAN
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 COOL WIND DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4982
Mailing Address - Country:US
Mailing Address - Phone:815-997-2664
Mailing Address - Fax:
Practice Address - Street 1:100 PIPER HILL DR STE A
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-477-1000
Practice Address - Fax:636-477-8962
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170237651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice