Dr. Glen Shanock, DDS
Dentist, Pediatric Dentistry in Long Beach, NY. Individual provider (NPI-1).
NPI number1871578377
StatusActive
Last updated in NPPESJul 13, 2026
Details
- NPI
- 1871578377
- Entity type
- Individual (NPI-1)
- Name
- Dr. Glen Shanock
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 7, 2005
- Last updated
- Jul 13, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - ORAL SURGERY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | 045836 | NY | Yes |
Practice location
120 W Park AveSuite 301
Long Beach, NY 11561-3301
Phone 516-431-5855
Mailing address
120 W Park AveSuite 301
Long Beach, NY 11561-3301
Phone 516-431-5855
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