Provider Demographics
NPI:1487792107
Name:SHULZE, RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SHULZE
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 1:12172 S LAUREL CHASE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4397
Mailing Address - Country:US
Mailing Address - Phone:720-442-3060
Mailing Address - Fax:
Practice Address - Street 1:12172 S LAUREL CHASE DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4397
Practice Address - Country:US
Practice Address - Phone:720-442-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO200107066OtherTIN