Provider Demographics
NPI:1346321049
Name:SHUMATE, NORMAN WATTS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:WATTS
Last Name:SHUMATE
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 1:1081 SW PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1944
Mailing Address - Country:US
Mailing Address - Phone:772-223-8954
Mailing Address - Fax:
Practice Address - Street 1:6035 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8104
Practice Address - Country:US
Practice Address - Phone:772-223-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN49531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice