Organization
CHARLES G SHEA DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES G SHEA DMD (OWNER)
(814) 535-7888
Entity
Organization
Contact information
Practice address
225 VINE ST, JOHNSTOWN, PA 15901
(814) 535-7888
(814) 539-8858
Mailing address
225 VINE ST, JOHNSTOWN, PA 15901
(814) 535-7888
(814) 539-8858
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS-018700-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015391880001
—
PA
01
—
160535
BS
PA
Enumeration date
02/13/2007
Last updated
09/19/2013
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