Provider Demographics
NPI:1205845708
Name:SHELLEY, LEXINGTON R JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEXINGTON
Middle Name:R
Last Name:SHELLEY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 RICHLAND AVENUE W
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801
Mailing Address - Country:US
Mailing Address - Phone:803-648-9348
Mailing Address - Fax:803-648-9376
Practice Address - Street 1:1420 RICHLAND AVENUE W
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-648-9348
Practice Address - Fax:803-648-9376
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics