Provider Demographics
NPI:1003985482
Name:SHELTON, CAROL (DMD RDH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:DMD RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82911 BEACH ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-9419
Mailing Address - Country:US
Mailing Address - Phone:541-922-6032
Mailing Address - Fax:
Practice Address - Street 1:82911 BEACH ACCESS RD. (TWO RIVERS CORRECTIONAL INST.)
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882
Practice Address - Country:US
Practice Address - Phone:541-922-6032
Practice Address - Fax:541-922-6008
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD79461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247952Medicaid