Provider Demographics
NPI:1700094760
Name:SHULTZ, RUDANE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUDANE
Middle Name:EDWARD
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:UMKC SCHOOL OF DENTISTRY
Mailing Address - Street 2:650 E. 25TH ST
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-235-2026
Mailing Address - Fax:816-235-6533
Practice Address - Street 1:650 E 25TH ST
Practice Address - Street 2:UMKC SCHOOL OF DENTISTRY
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2716
Practice Address - Country:US
Practice Address - Phone:816-235-2026
Practice Address - Fax:816-235-6533
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0143071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery