Provider Demographics
NPI:1922109768
Name:SHURE, JOHN RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:SHURE
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 1:12210 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1836
Mailing Address - Country:US
Mailing Address - Phone:718-634-9700
Mailing Address - Fax:718-474-7330
Practice Address - Street 1:12210 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1836
Practice Address - Country:US
Practice Address - Phone:718-634-9700
Practice Address - Fax:718-474-7330
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics