Provider Demographics
NPI:1275540197
Name:SHUKE, MICHAEL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:SHUKE
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 1:906 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAXTON
Mailing Address - State:PA
Mailing Address - Zip Code:16678
Mailing Address - Country:US
Mailing Address - Phone:814-635-3176
Mailing Address - Fax:814-635-3017
Practice Address - Street 1:906 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAXTON
Practice Address - State:PA
Practice Address - Zip Code:16678
Practice Address - Country:US
Practice Address - Phone:814-635-3176
Practice Address - Fax:814-635-3017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024088L122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist