Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7134 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 7134 | KY |
NPI | 1356330021 |
---|---|
Provider Name | Dr. Thad R Schulten |
First Address | Louisville, KY 40215-1109 |
Second Address | Louisville, KY 40215-1172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 28/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60000817 | MEDICAID DENTAL (01) | KY |
64032246 | (05) | KY |