| Kevin Brent Shedlock, Dds, Pc | |
|
Mile 187 Glenn Highway Glennallen AK 99588 | |
| (907) 320-0455 | |
| Not Available |
| Full Name | Kevin Brent Shedlock, Dds, Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | Mile 187 Glenn Highway, Glennallen, Alaska |
| Authorized Official Name and Position | Kevin Brent Shedlock (DENTIST) |
| Authorized Official Contact | 9073200455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kevin Brent Shedlock, Dds, Pc Po Box 789 Glennallen AK 99588 Ph: (907) 320-0455 | Kevin Brent Shedlock, Dds, Pc Mile 187 Glenn Highway Glennallen AK 99588 Ph: (907) 320-0455 |
| NPI Number | 1336547926 |
|---|---|
| Provider Enumeration Date | 12/12/2014 |
| Last Update Date | 12/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336547926 | NPI | - | NPPES |
| 1912241704 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 1001 (Alaska) | Primary |
Wrangell Mountain Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: Glenn Hwy. 187 Mp, Glennallen, AK 99588 Phone: 907-822-3113 Fax: 907-822-4045 |