Renee Schultz-Dietz, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

12016 Prairie Ave
Hebron, IL 60034-8892

Phone

(815) 648-4095

Fax

(815) 648-2881

NPI assigned

Feb 6, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Networks

• devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
• IL HMO C-SNP
• KY PPO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prairie Avenue Dental Associates, Inc.

  • General Practice Dentistry
  • Hebron, IL
  • NPI 1245428234
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013056720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12016 PRAIRIE AVE",
            "address_2": "PO BOX 75",
            "city": "HEBRON",
            "state": "IL",
            "postal_code": "600348892",
            "telephone_number": "815-648-4095",
            "fax_number": "815-648-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12016 PRAIRIE AVE",
            "city": "HEBRON",
            "state": "IL",
            "postal_code": "600348892",
            "telephone_number": "815-648-4095",
            "fax_number": "815-648-2881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULTZ-DIETZ",
        "first_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hebron Alden Greenwood Fire Protection District
• Nina C. Hernandez, MSW, LSW
• John Raymond Kaminski, DDS
• Sammie Mayerck, LSW
• Prairie Avenue Dental Associates, Inc.
• Veronique M Wolf, MS, LPC, CSAC

• General Practice Dentistry in Hebron, IL
• Providers in Hebron, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.