Provider Demographics
NPI:1982754081
Name:SCHULTZ, BRONSON C (DMD)
Entity Type:Individual
Prefix:
First Name:BRONSON
Middle Name:C
Last Name:SCHULTZ
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 1:525 N 400 W
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337
Mailing Address - Country:US
Mailing Address - Phone:435-257-7344
Mailing Address - Fax:435-257-8089
Practice Address - Street 1:525 N 400 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337
Practice Address - Country:US
Practice Address - Phone:435-257-7344
Practice Address - Fax:435-257-8089
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT533717899221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice