Kevin Kelso Schultz, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-018656 Issued in IL

Practice address

10 Heartland Dr
Suite C
Bloomington, IL 61704-7741

Phone

(309) 663-1721

NPI assigned

Jun 10, 2006

Last updated

Feb 19, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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)

Enrolled

State licenses

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

• Kevin K Schultz, DDS, PC

  • Dental Clinic/Center
  • Bloomington, IL
  • NPI 1447642384
  Authorized official Same address or phone

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424304000000",
    "number": "1427099167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 HEARTLAND DR",
            "address_2": "SUITE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047741",
            "telephone_number": "309-663-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HEARTLAND DR",
            "address_2": "SUITE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047741",
            "telephone_number": "309-663-1721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULTZ",
        "first_name": "KEVIN",
        "middle_name": "KELSO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-10",
        "last_updated": "2015-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-018656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carri L Schmitt, PT
• Kenneth Schoenig, MD
• Martin J Schroeder, MD
• Melissa Schruck, CCC, SLP-L
• Samantha Schuckles
• Jessica Ann Schulzki, BEHAVIOR ANALYST
• Adrienne Schupbach, M.D.
• Darla Schwertfeger, RN, CNIM
• Marta Halina Sciubisz, M.D.
• Stephanie Scolaro, PHARM.D.

• General Practice Dentistry in Bloomington, IL
• Providers in Bloomington, 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 Feb 19, 2015; 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.