Provider Demographics
NPI:1235164682
Name:SHUMAN, JEROME BENJAMIN (DMD MS ABO)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:BENJAMIN
Last Name:SHUMAN
Suffix:
Gender:M
Credentials:DMD MS ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2632
Mailing Address - Country:US
Mailing Address - Phone:207-797-5577
Mailing Address - Fax:
Practice Address - Street 1:132 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2632
Practice Address - Country:US
Practice Address - Phone:207-797-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist