Healthcare Provider Details

I. General information

NPI: 1346362597
Provider Name (Legal Business Name): NATHALIE SHOER DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W LAKE MARY BLVD SUITE 106
LAKE MARY FL
32746-3501
US

IV. Provider business mailing address

862 TAFT CT
PALM BEACH GARDENS FL
33410-1567
US

V. Phone/Fax

Practice location:
  • Phone: 407-328-6411
  • Fax: 407-328-6444
Mailing address:
  • Phone: 787-378-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN-17834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: