# KYRA JORDAN SHOCK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1578357372
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 016.0134368 | VT | Yes |
| 122300000X | Dentist | 0401419518 | VA | — |
| 122300000X | Dentist | 10000721 | MA | — |
| 122300000X | Dentist | 14377 | NC | — |
| 122300000X | Dentist | 14459 | CT | — |
| 122300000X | Dentist | 18769 | MD | — |
| 122300000X | Dentist | 6001990-15 | WI | — |

## Other

- **Enumeration date:** 04/07/2025
- **Last updated:** 07/09/2026