Provider Demographics
NPI:1861618498
Name:SCHULTZ, CLYDE (DDS)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W EL ROSE DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4023
Mailing Address - Country:US
Mailing Address - Phone:707-762-9784
Mailing Address - Fax:707-762-0772
Practice Address - Street 1:8 W EL ROSE DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4023
Practice Address - Country:US
Practice Address - Phone:707-762-9784
Practice Address - Fax:707-762-0772
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice