Provider Demographics
NPI:1871696146
Name:SCHULTHEIS, GENA (DDS)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:SCHULTHEIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 SOUTHERN MARYLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-2738
Mailing Address - Country:US
Mailing Address - Phone:410-257-7200
Mailing Address - Fax:410-257-9846
Practice Address - Street 1:10415 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2738
Practice Address - Country:US
Practice Address - Phone:410-257-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411165122300000X
MD14701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist