Healthcare Provider Details

I. General information

NPI: 1164534764
Provider Name (Legal Business Name): IAN E SHUMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 RITCHIE HWY SUITE 306
PASADENA MD
21122-1075
US

IV. Provider business mailing address

8028 RITCHIE HWY SUITE 306
PASADENA MD
21122-1075
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-5104
  • Fax:
Mailing address:
  • Phone: 410-766-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: