Robert Dale Shultz, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

5640 Clayton Cir
Roscoe, IL 61073-9503

Phone

(815) 623-7366

Fax

(815) 623-7331

NPI assigned

Oct 12, 2006

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Roscoe Family Dental Center, P.C.

  • General Practice Dentistry
  • Roscoe, IL
  • NPI 1780839837
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1588753016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8180 BURR OAK RD",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610739009",
            "telephone_number": "815-623-6185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 CLAYTON CIR",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610739503",
            "telephone_number": "815-623-7366",
            "fax_number": "815-623-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULTZ",
        "first_name": "ROBERT",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "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": []
}

• Joan M Schutz
• Steven Schutz, M.A., M.S.ED.
• Dusica Sekulic, MD
• Ronald P. Shelton, A.T.,C./L
• Heather Lynn Shick, D.M.D.
• Brooke E Silberhorn, DC
• Marlena Lynn Sjostrom
• Stefanie Renee Skaggs, LMT
• Kallie Smith, APRN
• Dana Smitley, PTA

• General Practice Dentistry in Roscoe, IL
• Providers in Roscoe, 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.