Provider Demographics
NPI:1174149421
Name:SHOEMAKER, MITCHELL (DDS)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10484 STRINGFELLOW RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ST JAMES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33956-3209
Mailing Address - Country:US
Mailing Address - Phone:239-283-1041
Mailing Address - Fax:239-283-1684
Practice Address - Street 1:10484 STRINGFELLOW RD STE 3
Practice Address - Street 2:
Practice Address - City:ST JAMES CITY
Practice Address - State:FL
Practice Address - Zip Code:33956-3209
Practice Address - Country:US
Practice Address - Phone:239-283-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist