Edward J. Shok, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS025460L Issued in PA

Practice address

90 Beaver Dr # 17
BDLG. D, Suite 209D
Du Bois, PA 15801-2440

Phone

(814) 375-0419

NPI assigned

Jan 2, 2007

Last updated

Jul 9, 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1245397330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 BEAVER DR # 17",
            "address_2": "BDLG. D, SUITE 209D",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158012440",
            "telephone_number": "814-375-0419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 BEAVER DR # 17",
            "address_2": "BDLG. D, SUITE 209D",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158012440",
            "telephone_number": "814-375-0419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOK",
        "first_name": "EDWARD",
        "middle_name": "J.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS025460L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011075580002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "476357",
            "state": "PW"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marilyn Jean Sheley, RN
• Patrick F. Shilala, D.O.
• Mariah L. Shimmel, PA-C
• Renu Shrinivas Shirguppi, DO
• Kimberlee Shoemaker-Thompson, DO
• Mikayla Marie Shute, DO
• W. John Siar, MD
• Nicholas E Sipes, PA-C
• Brady Martin Skiles, PA-C
• Skilled Medpros

• General Practice Dentistry in Du Bois, PA
• Providers in Du Bois, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.