Provider Demographics
NPI:1841606118
Name:SHUMWAY, JOSHUA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:SHUMWAY
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 1:4516 CANE RUN ROAD
Mailing Address - Street 2:P O BOX 16866
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40256
Mailing Address - Country:US
Mailing Address - Phone:502-448-1003
Mailing Address - Fax:502-448-1021
Practice Address - Street 1:4516 CANE RUN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3422
Practice Address - Country:US
Practice Address - Phone:502-448-1003
Practice Address - Fax:502-448-1021
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100324660Medicaid