Individual
EDWARD J. SHOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
90 BEAVER DR # 17, BDLG. D, SUITE 209D, DU BOIS, PA 15801-2440
(814) 375-0419
Mailing address
90 BEAVER DR # 17, BDLG. D, SUITE 209D, DU BOIS, PA 15801-2440
(814) 375-0419
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS025460L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011075580002
—
PA
01
—
476357
UNITED CONCORDIA
PW
Enumeration date
01/02/2007
Last updated
07/09/2007
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