Organization
JAMES M SHADDOCK DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES M SHADDOCK DDS (DENTIST)
(970) 356-2605
Entity
Organization
Contact information
Practice address
3705 W 12TH STREET, GREELEY, CO 80634
(970) 356-2605
(970) 304-6804
Mailing address
3705 W 12TH STREET, GREELEY, CO 80634
(970) 356-2605
(970) 304-6804
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
430
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02043016
—
CO
Enumeration date
11/29/2006
Last updated
08/22/2020
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