Provider Demographics
NPI:1952667180
Name:TERESA SCHULTZ DMD PLLC
Entity Type:Organization
Organization Name:TERESA SCHULTZ DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:479-879-6385
Mailing Address - Street 1:10662 UNION STAR CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-9581
Mailing Address - Country:US
Mailing Address - Phone:479-879-6385
Mailing Address - Fax:479-839-4398
Practice Address - Street 1:10662 UNION STAR CHURCH RD
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-9581
Practice Address - Country:US
Practice Address - Phone:479-879-6385
Practice Address - Fax:479-839-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3606261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental