Provider Demographics
NPI:1043284284
Name:SCHULZ, KYLE S (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:S
Last Name:SCHULZ
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 1:9 AMARANTH CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1034
Mailing Address - Country:US
Mailing Address - Phone:719-544-9106
Mailing Address - Fax:
Practice Address - Street 1:3911 OUTLOOK BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1624
Practice Address - Country:US
Practice Address - Phone:719-544-6788
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice