David J Shock, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12011164A Issued in IN

Practice address

215 E Washington St
Fairmount, IN 46928-1747

Phone

(765) 948-4107

NPI assigned

Jul 11, 2008

Last updated

Dec 11, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fairmount Family Dentist

  • Dental Clinic/Center
  • Fairmount, IN
  • NPI 1518412139
  NPD (past) Authorized official
• Sullivan-Hopkinson Dentistry LLC

  dba Hamilton Town Dentistry

  • General Practice Dentistry
  • Noblesville, IN
  • NPI 1366982027
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1174787865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E WASHINGTON ST",
            "city": "FAIRMOUNT",
            "state": "IN",
            "postal_code": "469281747",
            "telephone_number": "765-948-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E WASHINGTON ST",
            "city": "FAIRMOUNT",
            "state": "IN",
            "postal_code": "469281747",
            "telephone_number": "765-948-4107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCK",
        "first_name": "DAVID",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "683",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011164A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marion General Hospital (Fairmount Medical Associates)
• New Journeys Counseling
• Bharatkumar D Patel, MD
• Kundanbala Patel, MD
• Preferred Hospice Care, LLC
• Samantha Gayle Yeagy, ATC

• Dentist in Fairmount, IN
• Providers in Fairmount, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.