Provider Demographics
NPI:1316044993
Name:SHELTON, CLARENCE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:E
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:327 BEECHMONT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-4601
Mailing Address - Country:US
Mailing Address - Phone:914-633-8995
Mailing Address - Fax:212-932-0996
Practice Address - Street 1:50 W 97TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6053
Practice Address - Country:US
Practice Address - Phone:212-932-2203
Practice Address - Fax:212-932-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics