Provider Demographics
NPI:1811740764
Name:HALLOCK, SHANNON LEIGH
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 SYCAMORE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3186
Mailing Address - Country:US
Mailing Address - Phone:732-963-8680
Mailing Address - Fax:
Practice Address - Street 1:1029 SYCAMORE AVE STE 1
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3186
Practice Address - Country:US
Practice Address - Phone:732-963-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant