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General NPI Number Information
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NPI Number | 1356714331
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Entity Type | Organization
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Legal Business Name | DALE P SHEWMAKER DDS PC
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 10623 BRADDOCK RD
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City | FAIRFAX
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State | VA
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Zip | 22032-2202
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Country | US
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Telephone | 703-385-6960
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Fax |
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Provider Business Mailing Address
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Address Line | 10623 BRADDOCK RD
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City | FAIRFAX
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State | VA
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Zip | 22032-2202
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Country | US
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Telephone | 703-385-6960
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. DALE P SHEWMAKER
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Credential | DDS
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Telephone | 703-385-6960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401005882
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License Number State | VA
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