Todd David Shockley, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN15741 Issued in FL

Practice address

260 S Lawrence Blvd
Suite 102
Keystone Heights, FL 32656-9217

Phone

(352) 473-0707

Fax

(352) 473-5187

NPI assigned

Aug 28, 2007

Last updated

Aug 28, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188259200000",
    "number": "1194919779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 S LAWRENCE BLVD",
            "address_2": "SUITE 102",
            "city": "KEYSTONE HEIGHTS",
            "state": "FL",
            "postal_code": "326569217",
            "telephone_number": "352-473-0707",
            "fax_number": "352-473-5187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 S LAWRENCE BLVD",
            "address_2": "SUITE 102",
            "city": "KEYSTONE HEIGHTS",
            "state": "FL",
            "postal_code": "326569217",
            "telephone_number": "352-473-0707",
            "fax_number": "352-473-5187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKLEY",
        "first_name": "TODD",
        "middle_name": "DAVID",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-28",
        "last_updated": "2007-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN15741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Keystone Heights, FL
• Providers in Keystone Heights, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; 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.