Healthcare Provider Details

I. General information

NPI: 1174594725
Provider Name (Legal Business Name): WILLIAM G SHOEMAKER D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 24TH ST
YUMA AZ
85364-8551
US

IV. Provider business mailing address

120 W 24TH ST
YUMA AZ
85364-8551
US

V. Phone/Fax

Practice location:
  • Phone: 928-783-2106
  • Fax:
Mailing address:
  • Phone: 928-783-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD009402
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: