Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019.027715 | IL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 019.027715 | IL |
NPI | 1003048224 |
---|---|
Provider Name | Dr. Todd Alan Schultz |
First Address | Scott Afb, IL 62225-5250 |
Second Address | Scott Afb, IL 62225-5250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2009 |
Last Update Date | 28/09/2015 |