Individual
DR. LEO RUSSELL SHOCKLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
601 HIGHWAY 73, FLOODWOOD, MN 55736-8450
(218) 476-2969
(218) 476-1599
Mailing address
8991 W SHIPLEY RD, ALBORN, MN 55702-8277
(210) 393-5115
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9231
MN
Other
Enumeration date
10/26/2005
Last updated
05/09/2017
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