Provider Demographics
NPI:1386822302
Name:SHOEMAKER, ALICE KAMO (DDS)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:KAMO
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 EL PINAR
Mailing Address - Street 2:
Mailing Address - City:LA SELVA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:95076-1509
Mailing Address - Country:US
Mailing Address - Phone:831-684-1417
Mailing Address - Fax:
Practice Address - Street 1:167 EL PINAR
Practice Address - Street 2:
Practice Address - City:LA SELVA BEACH
Practice Address - State:CA
Practice Address - Zip Code:95076-1509
Practice Address - Country:US
Practice Address - Phone:831-684-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist