Healthcare Provider Details

I. General information

NPI: 1770691099
Provider Name (Legal Business Name): YOLANDA MARIE SHUMAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 CENTRAL CTR
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-851-5575
  • Fax: 740-851-4146
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.021468
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: