Provider Demographics
NPI:1629280987
Name:SHUMATE, NANCY ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELLEN
Last Name:SHUMATE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2600 N MAYFAIR RD STE 340
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1372
Mailing Address - Country:US
Mailing Address - Phone:414-259-0660
Mailing Address - Fax:414-259-0819
Practice Address - Street 1:2600 N MAYFAIR RD STE 340
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1372
Practice Address - Country:US
Practice Address - Phone:414-259-0660
Practice Address - Fax:414-259-0819
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50017351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics