Provider Demographics
NPI:1063542231
Name:SHEDLARSKI, JOSEPH G (D,D,S,)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:SHEDLARSKI
Suffix:
Gender:M
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 LAUDUN ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2225
Mailing Address - Country:US
Mailing Address - Phone:504-885-6920
Mailing Address - Fax:
Practice Address - Street 1:1808 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-3405
Practice Address - Country:US
Practice Address - Phone:504-361-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice