Individual
DR. CHARLES GORDON SHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
225 VINE ST, JOHNSTOWN, PA 15901-1518
(814) 535-7888
(814) 539-8858
Mailing address
225 VINE ST, JOHNSTOWN, PA 15901-1518
(814) 535-7888
(814) 539-8858
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS018700L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015391880001
—
PA
Enumeration date
09/27/2013
Last updated
09/30/2013
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