Provider Demographics
NPI:1457666760
Name:SHOEMAKER GHORBANIAN PLLC
Entity Type:Organization
Organization Name:SHOEMAKER GHORBANIAN PLLC
Other - Org Name:SUNRISE DENTAL OF SPOKANE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-220-6053
Mailing Address - Street 1:15701 E SPRAGUE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-5019
Mailing Address - Country:US
Mailing Address - Phone:509-924-0055
Mailing Address - Fax:509-924-0051
Practice Address - Street 1:15701 E SPRAGUE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-5019
Practice Address - Country:US
Practice Address - Phone:509-924-0055
Practice Address - Fax:509-924-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA99331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty