Healthcare Provider Details

I. General information

NPI: 1699465120
Provider Name (Legal Business Name): ADWAR SHAMUNA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15954 RIVERS EDGE DR
HAYWARD WI
54843-7800
US

IV. Provider business mailing address

9350 HARRITT RD
LAKESIDE CA
92040-3503
US

V. Phone/Fax

Practice location:
  • Phone: 715-634-2541
  • Fax:
Mailing address:
  • Phone: 619-792-8042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6002246-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: