DR. KENNETH DEMETRIC SHUMATE (NPI# 1417236613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417236613 |
| Entity Type | Individual |
| Full Name | DR. KENNETH DEMETRIC SHUMATE |
| Credential | D.D.S |
| Practice Address |
3010 Crain Hwy Suite 202 Waldorf MD 20601-2801 |
| Practice Telephone | 2405188928 |
| Practice Fax Number | 2405188931 |
| Mailing Telephone | 2405188928 |
| Mailing Fax Number | 2405188931 |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2016-08-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
0401413457 | VA | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
14944 | MD | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 067013800 | 05 |
| Street Address |
3010 CRAIN HWY SUITE 202 |
| City | WALDORF |
| State | MD |
| Zip Code | 20601-2801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114168192 | Luxxery Corporation of Maryland | Clinic/Center | 3010 Crain Hwy, Suite 400, Waldorf, MD 20601-2801 | 2009-03-20 |
| 1700184611 | Potomac Physical Therapy LLC | Physical Therapist | 3010 Crain Hwy, Suite 100, Waldorf, MD 20601-2801 | 2011-03-02 |
| 1609107598 | Kevin Renee Colvin | Physical Therapist | 3010 Crain Hwy, Suite 100, Waldorf, MD 20601-2801 | 2010-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154960128 | Sarian Beverly Wilson | Nurse Practitioner | 2203 Kayhill Dr, Waldorf, MD 20601 | 2019-12-23 |
| 1447778055 | Macy Alexandra Forman | Pharmacist | 3061 Tecnology Place, Waldorf, MD 20601 | 2017-09-04 |
| 1922523919 | Gregoire Mcclain | Counselor | Pathways Inc 2670 Crain Hwy, Suite 409, Waldorf, MD 20601 | 2017-08-10 |
| 1477091866 | Lutisse Cooper | Home Health Aide | 2520 Breakwater Court, Waldorf, MD 20601 | 2017-02-06 |
| 1609321637 | Kierra Jordan | Counselor | 2255 Crain Hwy Ste 102, Waldorf, MD 20601 | 2016-08-19 |
| 1215286828 | Linda Kline-lau | Counselor | 2255 Crain Highway, Waldorf, MD 20601 | 2012-08-29 |
| 1205124609 | Marian E. Kirk | Physical Therapist | 2960 Technology Place, Suite 110, Waldorf, MD 20601 | 2011-07-19 |
| 1932345238 | Patient First Maryland Medical Group | Non-Pharmacy Dispensing Site | 2855 Crain Highway, Waldorf, MD 20601 | 2008-12-17 |
| 1720150741 | Marianna Jeanne Patente | Counselor | 2670 Crain Highway, Suite #401, Waldorf, MD 20601 | 2006-11-14 |
| 1407940968 | Harold J. Pincus | Dentist | 2955 Crain Hwy., Waldorf, MD 20601 | 2006-10-02 |
| Find all providers in zip 20601 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588261085 | Rejuvenation Dental LLC | Dentist | 85 High St Ste 6, Waldorf, MD 20602-2150 | 2020-10-07 |
| 1801420112 | Adil Quraish Dds Waldorf PC | Dentist | 83 High St Ste A, Waldorf, MD 20602-2191 | 2020-02-25 |
| 1710423074 | Horace Ainsley Freeman | Dentist | 2992 Waldorf Market Pl, Waldorf, MD 20603-4874 | 2017-01-10 |
| 1639539653 | Rebecca N Triplett | Dentist | 3450 Old Washington Rd Ste 302, Waldorf, MD 20602-3251 | 2016-03-03 |
| 1821417700 | Michael Owens Dds of Waldorf LLC | Dentist | 152a Post Office Rd, Waldorf, MD 20602-2711 | 2014-04-08 |
| 1174848667 | Nakia Bush | Dentist | 11479 Berry Rd, Waldorf, MD 20603-5957 | 2010-03-29 |
| 1003061300 | Tongela Latarsha Williams | Dentist | 83 High Street, Suite A, Waldorf, MD 20602 | 2008-12-01 |
| 1720272677 | Gurpreet Singh Sethi Dds LLC | Dentist | 303 Post Office Rd, Suite B-1, Waldorf, MD 20602-2702 | 2007-09-04 |
| 1881809101 | David C Jones,jr. | Dentist | 4 Industrial Park Dr, Suite F, Waldorf, MD 20602-2757 | 2007-05-11 |
| 1013134931 | Donald P Peterson | Dentist | 11855 Holly Ln, Suite #103, Waldorf, MD 20601-3114 | 2007-04-20 |
| Find all providers in WALDORF | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.