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General NPI Number Information
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NPI Number | 1356782700
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Entity Type | Organization
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Legal Business Name | CHARLES G.SHEA,DMD,PC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 225 VINE ST
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City | JOHNSTOWN
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State | PA
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Zip | 15901-1518
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Country | US
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Telephone | 814-535-7888
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Fax | 814-539-8858
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Provider Business Mailing Address
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Address Line | 225 VINE ST
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City | JOHNSTOWN
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State | PA
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Zip | 15901-1518
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Country | US
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Telephone | 814-535-7888
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Fax | 814-539-8858
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. JACQUELINE M. SHEA
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Credential |
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Telephone | 814-535-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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