Provider Demographics
NPI:1811170384
Name:SHANDRICK, ROBERT STEVEN (DMD FAGD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:SHANDRICK
Suffix:
Gender:M
Credentials:DMD FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 STATE ROUTE 93
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249
Mailing Address - Country:US
Mailing Address - Phone:570-788-1870
Mailing Address - Fax:570-788-2446
Practice Address - Street 1:536 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249
Practice Address - Country:US
Practice Address - Phone:570-788-1870
Practice Address - Fax:570-788-2446
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022269L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice