Organization
KEVIN BRENT SHEDLOCK, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BRENT SHEDLOCK DDS (DENTIST)
(907) 320-0455
Entity
Organization
Contact information
Practice address
MILE 187 GLENN HIGHWAY, GLENNALLEN, AK 99588
(907) 320-0455
Mailing address
PO BOX 789, GLENNALLEN, AK 99588
(907) 320-0455
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1001
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912241704
—
AK
Enumeration date
12/12/2014
Last updated
12/12/2014
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