John William Hultquist, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4705 Issued in AL

Practice address

2200 Bergquist Dr
Suite 1
Lackland a F B, TX 78236-9907

Phone

(210) 292-5044

Fax

(210) 292-4946

NPI assigned

Sep 16, 2005

Sex

Male

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

Opted out of Medicare

Yes, effective Apr 23, 2026 through Apr 23, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284336000000",
    "number": "1194710053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 BERGQUIST DR",
            "address_2": "SUITE 1",
            "city": "LACKLAND A F B",
            "state": "TX",
            "postal_code": "782369907",
            "telephone_number": "210-292-5044",
            "fax_number": "210-292-4946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 BERGQUIST DR",
            "address_2": "SUITE 1",
            "city": "LACKLAND A F B",
            "state": "TX",
            "postal_code": "782369907",
            "telephone_number": "210-292-5044",
            "fax_number": "210-292-4946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULTQUIST",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2010-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "4705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Haveman, MSN, CPNP
• Garrett L Heitmann, PHARM.D.
• Melena K. Hewitt, MSW, LCSW
• Mark Allan Hinton, M.D.
• Charles Edwin Hulshof, LCSW
• Sharon Melissa Hunter, REGISTERED DIETITIAN
• Rajiv C Iyer, M.D.
• Kimberley Graham Jarutowicz, BCBA
• Jeffrey Johnson, PHARMD
• Lori Angela Johnson, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Lackland a F B, TX
• Providers in Lackland a F B, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.