DR. Charles Gordon Shea DMD

Overview of DR. Charles Gordon Shea DMD

• NPI number: 1063059160
• Provider type: Individual
• Specialty: Oral and Maxillofacial Surgery
• Gender: Male
• Active since: 09/27/2013
• Last updated: 09/30/2013

Primary Scrop of Practice

• Taxonomy Code: 1223S0112X
• Specialty: Oral and Maxillofacial Surgery
• License Number: DS018700L
• License State: PA

Provider Mailing Address

• Address: 225 Vine St
  Johnstown, PA 15901
• Phone: 814-535-7888
• Fax: 814-539-8858

Provider Practice Location

• Address: 225 Vine St
  Johnstown, PA 15901
• Phone: 814-535-7888
• Fax: 814-539-8858

Scope of Practice

• Taxonomy Code: 1223S0112X
• Specialty: Oral and Maxillofacial Surgery
• License Number: DS018700L
• License State: PA
• Switch: Yes

Legacy Identifiers

• Provider Identifier: 0015391880001
• Identifier Type: Medicare Oscar/Certification
• Identifier State: PA
• Issuer: