Provider Demographics
NPI:1659674562
Name:CHRISTOPHER B SHUMWAY DDS
Entity Type:Organization
Organization Name:CHRISTOPHER B SHUMWAY DDS
Other - Org Name:SHUMWAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SHUMWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-644-7400
Mailing Address - Street 1:100 E COMMERCE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9748
Mailing Address - Country:US
Mailing Address - Phone:262-644-7400
Mailing Address - Fax:262-644-7408
Practice Address - Street 1:100 E COMMERCE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-9748
Practice Address - Country:US
Practice Address - Phone:262-644-7400
Practice Address - Fax:262-644-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5724-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty