Provider Demographics
NPI:1114269982
Name:SHOEMAKER, CHELSEA A (DHAT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:A
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:DHAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 C ST
Mailing Address - Street 2:SUIITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3949
Mailing Address - Country:US
Mailing Address - Phone:907-564-2512
Mailing Address - Fax:907-277-1436
Practice Address - Street 1:172 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAND POINT
Practice Address - State:AK
Practice Address - Zip Code:99661
Practice Address - Country:US
Practice Address - Phone:907-564-2512
Practice Address - Fax:907-277-1436
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDHAT125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist