Provider Demographics
NPI:1376615823
Name:SHELL, JEFF THOMAS (D D S)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:THOMAS
Last Name:SHELL
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 BEE CAVES RD
Mailing Address - Street 2:C 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6465
Mailing Address - Country:US
Mailing Address - Phone:512-330-9016
Mailing Address - Fax:512-330-9962
Practice Address - Street 1:4201 BEE CAVES RD
Practice Address - Street 2:C 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6465
Practice Address - Country:US
Practice Address - Phone:512-330-9016
Practice Address - Fax:512-330-9962
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics