Provider Demographics
NPI:1790870053
Name:SHOEMAKER, RICHARD PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N SHIPP ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-5725
Mailing Address - Country:US
Mailing Address - Phone:505-393-8069
Mailing Address - Fax:505-397-6050
Practice Address - Street 1:506 N SHIPP ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5725
Practice Address - Country:US
Practice Address - Phone:505-393-8069
Practice Address - Fax:505-397-6050
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice