Provider Demographics
NPI:1720277320
Name:SCHUETZ, ERIC J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:SCHUETZ
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 1:1050 CEDAR CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3054
Mailing Address - Country:US
Mailing Address - Phone:305-696-0660
Mailing Address - Fax:
Practice Address - Street 1:610 NE 124TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5523
Practice Address - Country:US
Practice Address - Phone:305-893-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2013-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071706100Medicaid