Provider Demographics
NPI:1184857633
Name:SHROPSHIRE, JACK CLIFTON (DDS)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:CLIFTON
Last Name:SHROPSHIRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ARAPAHO RD
Mailing Address - Street 2:
Mailing Address - City:RANSOM CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79366-2216
Mailing Address - Country:US
Mailing Address - Phone:806-829-2550
Mailing Address - Fax:806-687-5957
Practice Address - Street 1:1313 BROADWAY STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3209
Practice Address - Country:US
Practice Address - Phone:806-765-2605
Practice Address - Fax:806-687-5957
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice