Healthcare Provider Details

I. General information

NPI: 1134417827
Provider Name (Legal Business Name): RICAHRD P SHUMATE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 TALMADGE RD
TOLEDO OH
43623-2167
US

IV. Provider business mailing address

9718 FAIRMEADOWS LN
WHITEHOUSE OH
43571-9018
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-9611
  • Fax: 419-474-1902
Mailing address:
  • Phone: 419-215-7239
  • Fax: 419-474-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: