Provider Demographics
NPI:1134273600
Name:DR. GORDON D SCHULTE PC
Entity type:Organization
Organization Name:DR. GORDON D SCHULTE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-987-2721
Mailing Address - Street 1:1110 W 5TH ST
Mailing Address - Street 2:PO BOX 9
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013
Mailing Address - Country:US
Mailing Address - Phone:605-987-2721
Mailing Address - Fax:605-987-3312
Practice Address - Street 1:1110 W 5TH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013
Practice Address - Country:US
Practice Address - Phone:605-987-2721
Practice Address - Fax:605-987-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty