MEDICARE: DR. THOMAS JOSEPH SHONIKER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.025879	OH

General Provider Information

NPI Number	:	1053973818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JOSEPH SHONIKER DMD

Provider Business Mailing Address
First Line	:	3434 M 119
Second Line	:	STE H
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-9373
Country	:	US
Telephone Number	:	231-251-9083
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 MENTOR AVE STE 280
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-8715
Country	:	US
Telephone Number	:	440-352-2887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	06/24/2020

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