Provider Demographics
NPI:1275752321
Name:SHELTON, STEVEN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
Last Name:SHELTON
Suffix:
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:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-2063
Mailing Address - Country:US
Mailing Address - Phone:928-532-3040
Mailing Address - Fax:928-537-2525
Practice Address - Street 1:51 S WHITE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-6105
Practice Address - Country:US
Practice Address - Phone:928-532-3040
Practice Address - Fax:928-537-2525
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics