Provider Demographics
NPI:1356407092
Name:SHOEMAKER, DALE R (DDS)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:SHOEMAKER
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 1:4828 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3721
Mailing Address - Country:US
Mailing Address - Phone:616-940-3033
Mailing Address - Fax:616-940-3043
Practice Address - Street 1:4828 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3721
Practice Address - Country:US
Practice Address - Phone:616-940-3033
Practice Address - Fax:616-940-3043
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010127331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice