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General NPI Number Information
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NPI Number | 1578357372
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Entity Type | Individual
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Provider Name | KYRA JORDAN SHOCK DDS
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 4409 INTREPID CIR
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City | NORMAN
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State | OK
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Zip | 73072-4300
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Country | US
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Telephone | 405-808-4522
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Fax |
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Provider Business Mailing Address
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Address Line | 4409 INTREPID CIR
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City | NORMAN
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State | OK
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Zip | 73072-4300
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Country | US
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Telephone | 405-808-4522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14459
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401419518
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18769
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14377
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10000721
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License Number State | MA
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Taxonomy #6
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 016.0134368
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License Number State | VT
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