Provider Demographics
NPI:1851878235
Name:SHOOK, GREGORY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:SHOOK
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 1:2575 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4667
Mailing Address - Country:US
Mailing Address - Phone:503-378-5528
Mailing Address - Fax:
Practice Address - Street 1:2575 CENTER STREET NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4667
Practice Address - Country:US
Practice Address - Phone:503-378-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD61991223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health