Provider Demographics
NPI:1255691085
Name:SHUMATE, ROBERT CORRY (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CORRY
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 1:4121 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8954
Mailing Address - Country:US
Mailing Address - Phone:812-858-3100
Mailing Address - Fax:812-858-3110
Practice Address - Street 1:4121 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8954
Practice Address - Country:US
Practice Address - Phone:812-858-3100
Practice Address - Fax:812-858-3100
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012662A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery