Provider Demographics
NPI:1639236029
Name:SHUMATE, JILL E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:E
Last Name:SHUMATE
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 1:403 THIRD AVE.
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:681-207-7065
Mailing Address - Fax:681-207-7087
Practice Address - Street 1:403 THIRD AVE.
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:681-207-7065
Practice Address - Fax:681-207-7087
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003102Medicaid
WV3810003102Medicaid
WVWV0988AMedicare PIN