Provider Demographics
NPI:1760964845
Name:SCHULTE, CONRAD MAX (DMD)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:MAX
Last Name:SCHULTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20887 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3675
Mailing Address - Country:US
Mailing Address - Phone:541-218-4205
Mailing Address - Fax:
Practice Address - Street 1:16461 WILLIAM FOSS RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9486
Practice Address - Country:US
Practice Address - Phone:541-907-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD119501223G0001X
CA103174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist