KEVIN BRENT SHEDLOCK, DDS, PC; NPI #1336547926

Contact Information

KEVIN BRENT SHEDLOCK, DDS, PC

MILE 187 GLENN HIGHWAY
GLENNALLEN, AK 99588

Phone: 907-320-0455
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Dental	261QD0000X

Indicates primary specialty

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NPI Profile & details for KEVIN BRENT SHEDLOCK, DDS, PC

NPI Number 1336547926

LBN Legal business name KEVIN BRENT SHEDLOCK, DDS, PC

Authorized official KEVIN SHEDLOCK - (DENTIST)

Entity Organization

Organization subpart ¹ No

Enumeration date 12/12/2014

Last updated 12/12/2014 - About 11 years ago

Identifiers

AK	License #	1001
AK	Medicaid	1912241704

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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