Provider Demographics
NPI:1376548313
Name:SHUMAN, STEPHEN K (DDS, MS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:SHUMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1926
Mailing Address - Country:US
Mailing Address - Phone:651-482-9749
Mailing Address - Fax:
Practice Address - Street 1:793 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1926
Practice Address - Country:US
Practice Address - Phone:651-482-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2011-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND100811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice