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General NPI Number Information
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NPI Number | 1134613565
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Entity Type | Organization
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Legal Business Name | JASON E SHOCKLEY MS, DDS, PLLC
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 580 PERSHING ST
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City | CRAIG
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State | CO
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Zip | 81625-3047
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Country | US
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Telephone | 970-824-9785
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Fax | 970-824-2215
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Provider Business Mailing Address
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Address Line | 580 PERSHING ST
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City | CRAIG
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State | CO
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Zip | 81625-3047
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Country | US
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Telephone | 970-761-3365
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Fax | 970-824-2215
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JASON E SHOCKLEY
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Credential | MS, DDS
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Telephone | 970-824-9785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DEN.00203594
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License Number State | CO
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