Provider Demographics
NPI:1508352147
Name:TESAR, SHELBY ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:TESAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-6430
Mailing Address - Country:US
Mailing Address - Phone:319-521-3870
Mailing Address - Fax:
Practice Address - Street 1:695 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8008
Practice Address - Country:US
Practice Address - Phone:303-698-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist