Provider Demographics
NPI:1134122120
Name:CANADA, SHELLEY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:LYNN
Last Name:CANADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8556 KATY FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1806
Mailing Address - Country:US
Mailing Address - Phone:713-957-8668
Mailing Address - Fax:713-957-3441
Practice Address - Street 1:8556 KATY FWY STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1806
Practice Address - Country:US
Practice Address - Phone:713-957-8668
Practice Address - Fax:713-957-3441
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice