MEDICARE: DR. JOEL ANDREW SHUMWAY DDS

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	122300000X	Dentist	D6607	AZ

General Provider Information

NPI Number	:	1225095474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL ANDREW SHUMWAY DDS

Provider Business Mailing Address
First Line	:	951 S LINDA CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-4627
Country	:	US
Telephone Number	:	480-892-7155
Fax Number	:

Provider Business Practice Location Address
First Line	:	951 S LINDA CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-4627
Country	:	US
Telephone Number	:	480-892-7155
Fax Number	:

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/17/2008

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