Provider Demographics
NPI:1518310655
Name:JAMES S SHELBY D.D.S
Entity Type:Organization
Organization Name:JAMES S SHELBY D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-326-5454
Mailing Address - Street 1:3233 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4761
Mailing Address - Country:US
Mailing Address - Phone:509-326-5454
Mailing Address - Fax:509-326-0314
Practice Address - Street 1:3233 W INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4761
Practice Address - Country:US
Practice Address - Phone:509-326-5454
Practice Address - Fax:509-326-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7654261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental