Provider Demographics
NPI:1093857807
Name:SHUMATE, JOE ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:ARTHUR
Last Name:SHUMATE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 MASON RD
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4542
Mailing Address - Country:US
Mailing Address - Phone:503-789-4770
Mailing Address - Fax:
Practice Address - Street 1:383 GREENS RD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1907
Practice Address - Country:US
Practice Address - Phone:281-872-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7145122300000X
TX28060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty