Provider Demographics
NPI:1871712901
Name:SHULTS, INGRID E (DDS)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:E
Last Name:SHULTS
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 1:9532 179TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-9602
Mailing Address - Country:US
Mailing Address - Phone:708-444-2273
Mailing Address - Fax:708-444-7380
Practice Address - Street 1:9532 179TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-9602
Practice Address - Country:US
Practice Address - Phone:708-444-2273
Practice Address - Fax:708-444-7380
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice