Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D8754 | MN |
NPI | 1003860727 |
---|---|
Provider Name | William Jack Schuldt JR. |
First Address | Duluth, MN 55802-1711 |
Second Address | Duluth, MN 55802-1711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |