Provider Demographics
NPI:1255459269
Name:SHAMUL, JOHN W (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SHAMUL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 DEER PARK AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1319
Mailing Address - Country:US
Mailing Address - Phone:631-587-8493
Mailing Address - Fax:631-587-6667
Practice Address - Street 1:678 DEER PARK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1319
Practice Address - Country:US
Practice Address - Phone:631-587-8493
Practice Address - Fax:631-587-6667
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042439-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics