Provider Demographics
NPI:1871482596
Name:STULTZ, JEREMY CHARLES I
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:CHARLES
Last Name:STULTZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7225
Mailing Address - Country:US
Mailing Address - Phone:813-695-2557
Mailing Address - Fax:
Practice Address - Street 1:97 FLAGLER PLAZA DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-5965
Practice Address - Country:US
Practice Address - Phone:386-693-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist