Provider Demographics
NPI:1164693750
Name:FRANK W. SHELTON, JR.
Entity Type:Organization
Organization Name:FRANK W. SHELTON, JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-383-6648
Mailing Address - Street 1:411 ANDREWS RD
Mailing Address - Street 2:UNIT #210
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2993
Mailing Address - Country:US
Mailing Address - Phone:919-383-6648
Mailing Address - Fax:919-383-1133
Practice Address - Street 1:411 ANDREWS RD
Practice Address - Street 2:UNIT #210
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2993
Practice Address - Country:US
Practice Address - Phone:919-383-6648
Practice Address - Fax:919-383-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC249821OtherAMERITAS