Leo Russell Shockley Jr., D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9231 Issued in MN

Practice address

601 Highway 73
Floodwood, MN 55736-8450

Phone

(218) 476-2969

Fax

(218) 476-1599

NPI assigned

Oct 26, 2005

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494288000000",
    "number": "1942290226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8991 W SHIPLEY RD",
            "city": "ALBORN",
            "state": "MN",
            "postal_code": "557028277",
            "telephone_number": "210-393-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 HIGHWAY 73",
            "city": "FLOODWOOD",
            "state": "MN",
            "postal_code": "557368450",
            "telephone_number": "218-476-2969",
            "fax_number": "218-476-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKLEY",
        "first_name": "LEO",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2017-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neil Raymond Johnson
• Clayton Albin Lewandowski, DDS
• Northland Neurology and Myology PA
• Heidi Jean Schminski, APRN, CNP
• Dawn Christine Shafer, RN-CFNP
• James Richard Swanstrom, DDS.
• Antonio Timbol Toledo, M.D.
• Abigail Jo Veroeven, DDS

• General Practice Dentistry in Floodwood, MN
• Providers in Floodwood, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2017; 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.