Basic Information
| Provider Information | |||||||||
| NPI: | 1093857807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUMATE | ||||||||
| FirstName: | JOE | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8210 MASON RD | ||||||||
| Address2: | |||||||||
| City: | MANVEL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775784542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037894770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 383 GREENS RD STE A | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770601907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818723777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 09/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D7145 | OR | N | Dental Providers | Dentist | 122300000X | 28060 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.