Active NPI
Clyde Schultz, DDS
- General Practice Dentistry
- Petaluma, CA
National Provider Identifier
1861618498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 25838
- Practice address
- 8 W El Rose Dr
Petaluma, CA 94952-4023 - Phone
- (707) 762-9784
- Fax
- (707) 762-0772
- NPI assigned
- Apr 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 25838 | CA | Primary |
Addresses
Primary practice location
8 W El Rose Dr
Petaluma, CA 94952-4023
Mailing address
8 W El Rose Dr
Petaluma, CA 94952-4023
Phone (707) 762-9784
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25838 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640217600000",
"number": "1861618498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 W EL ROSE DR",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949524023",
"telephone_number": "707-762-9784",
"fax_number": "707-762-0772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 W EL ROSE DR",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949524023",
"telephone_number": "707-762-9784",
"fax_number": "707-762-0772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHULTZ",
"first_name": "CLYDE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-18",
"last_updated": "2021-12-23",
"certification_date": "2021-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "25838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.