Provider Demographics
NPI:1871628032
Name:SCHULZ, LARRY GENE (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GENE
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:G
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1901 MEDI PARK
Mailing Address - Street 2:STE 219
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106
Mailing Address - Country:US
Mailing Address - Phone:806-356-7744
Mailing Address - Fax:806-356-7074
Practice Address - Street 1:1901 MEDI PARK
Practice Address - Street 2:STE 219
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-356-7744
Practice Address - Fax:806-356-7074
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16448Medicare UPIN