Healthcare Provider Details

I. General information

NPI: 1528094158
Provider Name (Legal Business Name): JAMES JOSEPH SHUBERT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 EAGLE VIEW DR
BUFFALO WY
82834-1422
US

IV. Provider business mailing address

630 SUMMIT DR
BUFFALO WY
82834-1435
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-9627
  • Fax:
Mailing address:
  • Phone: 307-684-0119
  • Fax: 307-684-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1136
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: