Kenneth Demetric Shumate, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14944 Issued in MD

Practice address

3010 Crain Hwy
Suite 202
Waldorf, MD 20601-2801

Phone

(240) 518-8928

Fax

(240) 518-8931

NPI assigned

Aug 5, 2011

Last updated

Aug 8, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470614400000",
    "number": "1417236613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 CRAIN HWY",
            "address_2": "SUITE 202",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012801",
            "telephone_number": "240-518-8928",
            "fax_number": "240-518-8931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 CRAIN HWY",
            "address_2": "SUITE 202",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012801",
            "telephone_number": "240-518-8928",
            "fax_number": "240-518-8931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMATE",
        "first_name": "KENNETH",
        "middle_name": "DEMETRIC",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-05",
        "last_updated": "2016-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "14944",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401413457",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067013800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela A Sheridan, PTA
• Grace Shodiya, DPT
• Elias Petros Showler
• Adebisi Olubunmi Showunmi
• Dreama Shuler, DNP, PMHNP-BC
• Ashley C Siemonh, N.P.
• Carolina Sierra
• Paul Barry Silberman, DDS
• Jennifer Silver, LCPC
• Simmons Speech Therapy LLC

• General Practice Dentistry in Waldorf, MD
• Providers in Waldorf, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.