Provider Demographics
NPI:1992392708
Name:SHOEMAKER DENTAL
Entity Type:Organization
Organization Name:SHOEMAKER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:CECILE
Authorized Official - Last Name:CHURINETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-692-5826
Mailing Address - Street 1:6244 POPLAR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4729
Mailing Address - Country:US
Mailing Address - Phone:901-682-5826
Mailing Address - Fax:901-761-5674
Practice Address - Street 1:6244 POPLAR AVE STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4729
Practice Address - Country:US
Practice Address - Phone:901-682-5826
Practice Address - Fax:901-761-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental