MEDICARE: TYLER S SHOEMAKER 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	DE00009933	WA

General Provider Information

NPI Number	:	1861465007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER S SHOEMAKER DMD

Provider Business Mailing Address
First Line	:	101 W CASCADE WAY
Second Line	:	#101
City	:	SPOKANE
State	:	WA
Zip	:	99208-6000
Country	:	US
Telephone Number	:	509-468-0490
Fax Number	:	509-468-1814

Provider Business Practice Location Address
First Line	:	101 W CASCADE WAY
Second Line	:	#101
City	:	SPOKANE
State	:	WA
Zip	:	99208-6000
Country	:	US
Telephone Number	:	509-468-0490
Fax Number	:	509-468-1814

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/12/2007

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