Individual
DR. KENNETH DEMETRIC SHUMATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
3010 CRAIN HWY, SUITE 202, WALDORF, MD 20601-2801
(240) 518-8928
(240) 518-8931
Mailing address
3010 CRAIN HWY, SUITE 202, WALDORF, MD 20601-2801
(240) 518-8928
(240) 518-8931
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401413457
VA
1223G0001X
General Practice Dentistry
Primary
14944
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067013800
—
MD
Enumeration date
08/05/2011
Last updated
08/08/2016
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