Provider Demographics
NPI:1164596193
Name:SHOOK, JASON H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:H
Last Name:SHOOK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 HWY 64 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904
Mailing Address - Country:US
Mailing Address - Phone:828-389-2168
Mailing Address - Fax:828-389-4827
Practice Address - Street 1:1847 HWY 64 BUSINESS
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904
Practice Address - Country:US
Practice Address - Phone:828-389-2168
Practice Address - Fax:828-389-4827
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice