Provider Demographics
NPI:1770779548
Name:SCHULTZ, CHARLES J (DDS, OMFS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DDS, OMFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 DUNN ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1430
Mailing Address - Country:US
Mailing Address - Phone:907-586-9586
Mailing Address - Fax:907-586-1849
Practice Address - Street 1:2220 DUNN ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9304
Practice Address - Country:US
Practice Address - Phone:907-586-9586
Practice Address - Fax:907-586-1849
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9611223S0112X
AK1111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDDO961Medicaid
AK1003247Medicaid