Provider Demographics
NPI:1326154337
Name:SHUMAKER, BRYAN ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ALLAN
Last Name:SHUMAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 STATE ROUTE 34 S
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1783
Mailing Address - Country:US
Mailing Address - Phone:732-431-0800
Mailing Address - Fax:732-431-1694
Practice Address - Street 1:81 STATE ROUTE 34 S
Practice Address - Street 2:SUITE D
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1783
Practice Address - Country:US
Practice Address - Phone:732-431-0800
Practice Address - Fax:732-431-1694
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ121811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice