Provider Demographics
NPI:1629636543
Name:SHUMWAY, CHARLES LARON (BS, DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LARON
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:BS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6681
Mailing Address - Country:US
Mailing Address - Phone:208-521-5388
Mailing Address - Fax:
Practice Address - Street 1:2900 CENTRAL AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8626
Practice Address - Country:US
Practice Address - Phone:406-656-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-173541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice