Provider Demographics
NPI:1699766204
Name:SHOEMAKER, DANIEL JAMES (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 NEWFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1857
Mailing Address - Country:US
Mailing Address - Phone:860-613-0553
Mailing Address - Fax:860-613-0206
Practice Address - Street 1:828 NEWFIELD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1857
Practice Address - Country:US
Practice Address - Phone:860-613-0553
Practice Address - Fax:860-613-0206
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT70501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry