Provider Demographics
NPI:1356714331
Name:DALE P SHEWMAKER DDS PC
Entity type:Organization
Organization Name:DALE P SHEWMAKER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHEWMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-385-6960
Mailing Address - Street 1:10623 BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2202
Mailing Address - Country:US
Mailing Address - Phone:703-385-6960
Mailing Address - Fax:
Practice Address - Street 1:10623 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2202
Practice Address - Country:US
Practice Address - Phone:703-385-6960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010058821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty