# KEVIN BRENT SHEDLOCK, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336547926
- **Authorized official:** KEVIN BRENT SHEDLOCK DDS (DENTIST)
- **Authorized official phone:** (907) 320-0455

## Contact information

- **Practice address:** MILE 187 GLENN HIGHWAY, GLENNALLEN, AK 99588
- **Practice address phone:** (907) 320-0455
- **Mailing address:** PO BOX 789, GLENNALLEN, AK 99588
- **Mailing address phone:** (907) 320-0455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 1001 | AK | Yes |

## Other

- **Enumeration date:** 12/12/2014
- **Last updated:** 12/12/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1912241704 | — | AK |