Provider Demographics
NPI:1679827018
Name:DAVID M SHEMO DMD
Entity Type:Organization
Organization Name:DAVID M SHEMO DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-822-4065
Mailing Address - Street 1:360 KIDDER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5619
Mailing Address - Country:US
Mailing Address - Phone:570-822-4065
Mailing Address - Fax:570-820-9836
Practice Address - Street 1:360 KIDDER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5619
Practice Address - Country:US
Practice Address - Phone:570-822-4065
Practice Address - Fax:570-820-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty