NPIMap

Organization Active NPI

Kevin K Schultz, DDS, PC

  • Dental Clinic/Center
  • Bloomington, IL
National Provider Identifier
1447642384
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019.018656 Issued in IL
Legal business name
KEVIN K SCHULTZ, DDS, PC
Practice address
10 Heartland Dr
Suite C
Bloomington, IL 61704-7741
Phone
(309) 663-1721
NPI assigned
Mar 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Authorized official

Name
Dr. Kevin Kelso Schultz, D.D.S.
Title
President
Phone
(309) 663-1721

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019.018656 IL Primary

Addresses

Primary practice location

10 Heartland Dr
Suite C
Bloomington, IL 61704-7741

Mailing address

10 Heartland Dr
Suite C
Bloomington, IL 61704-7741
Phone (309) 663-1721

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1447642384",
    "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": {
        "organization_name": "KEVIN K SCHULTZ, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-02",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "KELSO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-663-1721",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019.018656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.