Provider Demographics
NPI:1205383924
Name:SHOCK, PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:SHOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 GERMANTOWN PIKE STE 104
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-7401
Mailing Address - Country:US
Mailing Address - Phone:484-681-9718
Mailing Address - Fax:484-681-9852
Practice Address - Street 1:920 GERMANTOWN PIKE STE 104
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-7401
Practice Address - Country:US
Practice Address - Phone:484-681-9718
Practice Address - Fax:484-681-9852
Is Sole Proprietor?:No
Enumeration Date:2016-09-11
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0409911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice