Provider Demographics
NPI:1366589921
Name:SHMURAK, IGOR GARY (DMD)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:GARY
Last Name:SHMURAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:SHMURAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, FICOI
Mailing Address - Street 1:1600 HORIZON DR STE 119
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-4100
Mailing Address - Country:US
Mailing Address - Phone:215-996-9968
Mailing Address - Fax:215-996-9971
Practice Address - Street 1:1600 HORIZON DR STE 119
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-4100
Practice Address - Country:US
Practice Address - Phone:215-996-9968
Practice Address - Fax:215-996-9971
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015266560001Medicaid
PA1015266560001Medicaid