Provider Demographics
NPI:1336403153
Name:SCHULTE, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SCHULTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 COUNTY ROAD 220
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4902
Mailing Address - Country:US
Mailing Address - Phone:904-278-6229
Mailing Address - Fax:904-269-3529
Practice Address - Street 1:1647 COUNTY ROAD 220
Practice Address - Street 2:SUITE 101
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4902
Practice Address - Country:US
Practice Address - Phone:904-278-6229
Practice Address - Fax:904-269-3529
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist