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Individual

KALEB BLAINE SHUMARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
1353 E MOUND RD STE 102, DECATUR, IL 62526-3676
(217) 877-1601
Mailing address
4574 NICKLAUS CT, DECATUR, IL 62526-9315
(217) 259-5660

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019036105
IL

Other

Enumeration date
06/16/2025
Last updated
06/16/2025
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