Provider Demographics
NPI:1013191121
Name:TYLER SHOEMAKER,DMD,PS
Entity Type:Organization
Organization Name:TYLER SHOEMAKER,DMD,PS
Other - Org Name:PINEVIEW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOYANAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-468-0490
Mailing Address - Street 1:101 W CASCADE WAY
Mailing Address - Street 2:#101
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6000
Mailing Address - Country:US
Mailing Address - Phone:509-468-0490
Mailing Address - Fax:509-468-1814
Practice Address - Street 1:101 W CASCADE WAY
Practice Address - Street 2:#101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6000
Practice Address - Country:US
Practice Address - Phone:509-468-0490
Practice Address - Fax:509-468-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000099331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty