Individual
DR. THAD R SCHULTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4515 CHURCHMAN AVE, LOUISVILLE, KY 40215-1172
(502) 361-0134
(502) 361-0137
Mailing address
4515 CHURCHMAN AVE, LOUISVILLE, KY 40215-1109
(502) 361-0134
(502) 361-0137
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7134
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
7134
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60000817
MEDICAID DENTAL
KY
05
—
64032246
—
KY
Enumeration date
10/17/2005
Last updated
08/28/2014
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