Provider Demographics
NPI:1396722807
Name:GREGORY L SCHULTZ DMD PC
Entity type:Organization
Organization Name:GREGORY L SCHULTZ DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-776-7656
Mailing Address - Street 1:209 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1124
Mailing Address - Country:US
Mailing Address - Phone:607-776-7656
Mailing Address - Fax:607-776-7858
Practice Address - Street 1:209 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1124
Practice Address - Country:US
Practice Address - Phone:607-776-7656
Practice Address - Fax:607-776-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00458177Medicaid