Provider Demographics
NPI:1982784377
Name:SCHULTHEIS, OTIS D (DDS)
Entity Type:Individual
Prefix:DR
First Name:OTIS
Middle Name:D
Last Name:SCHULTHEIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14061 SAINT FRANCIS BLVD
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4692
Mailing Address - Country:US
Mailing Address - Phone:763-576-1855
Mailing Address - Fax:763-421-0519
Practice Address - Street 1:14061 SAINT FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-4692
Practice Address - Country:US
Practice Address - Phone:763-576-1855
Practice Address - Fax:763-421-0519
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN93381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice