Provider Demographics
NPI:1114349479
Name:SHELTON, ANGELA REESE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:REESE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40159-0778
Mailing Address - Country:US
Mailing Address - Phone:270-352-5566
Mailing Address - Fax:270-352-5602
Practice Address - Street 1:299 W LINCOLN TRAIL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-3306
Practice Address - Country:US
Practice Address - Phone:270-352-5566
Practice Address - Fax:270-352-5602
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist