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General NPI Number Information
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NPI Number | 1487207700
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Entity Type | Organization
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Legal Business Name | VICTORIA A. SHOOK, D.D.S., A PROFESSIONAL CORP.
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 28138 S. WESTERN AVE.
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City | SAN PEDRO
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State | CA
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Zip | 90732
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Country | US
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Telephone | 310-548-2830
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Fax | 310-548-2833
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Provider Business Mailing Address
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Address Line | 28138 S. WESTERN AVE.
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City | SAN PEDRO
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State | CA
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Zip | 90732
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Country | US
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Telephone | 310-548-2830
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Fax | 310-548-2833
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Authorized Official
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Title or Position | C.E.O./DENTIST
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Name | VICTORIA ANN SHOOK
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Credential | DDS
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Telephone | 310-548-2830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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