Provider Demographics
NPI:1306159074
Name:SHOEMAKER GHORBANIAN I PLLC
Entity type:Organization
Organization Name:SHOEMAKER GHORBANIAN I PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-536-9999
Mailing Address - Street 1:104 S FREYA ST
Mailing Address - Street 2:TURQUOISE FLAG BUILDING SUITE 127
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4862
Mailing Address - Country:US
Mailing Address - Phone:509-536-9998
Mailing Address - Fax:509-536-9998
Practice Address - Street 1:104 S FREYA ST
Practice Address - Street 2:TURQUOISE FLAG BUILDING SUITE 127
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4862
Practice Address - Country:US
Practice Address - Phone:509-536-9998
Practice Address - Fax:509-536-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6030156471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty