Provider Demographics
NPI:1184285850
Name:SHOOK, MONICA SHEA (DMD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:SHEA
Last Name:SHOOK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:HOSANNA MARIE
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3063 MEADOWLARK LN STE 60
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2660
Mailing Address - Country:US
Mailing Address - Phone:715-835-1233
Mailing Address - Fax:
Practice Address - Street 1:3063 MEADOWLARK LN STE 60
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2660
Practice Address - Country:US
Practice Address - Phone:715-835-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002139-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice