Provider Demographics
NPI:1588800791
Name:WILLIAM E SHELTON DDS PA
Entity Type:Organization
Organization Name:WILLIAM E SHELTON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-7529
Mailing Address - Street 1:1985 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7309
Mailing Address - Country:US
Mailing Address - Phone:870-793-7529
Mailing Address - Fax:870-793-7867
Practice Address - Street 1:1985 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7309
Practice Address - Country:US
Practice Address - Phone:870-793-7529
Practice Address - Fax:870-793-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58273OtherBLUE CROSS BLUE SHIELD OF ARKANSAS
TN4142807OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
AR52015485OtherBLUE CROSS BLUE SHIELD OF ALABAMA
823067OtherUNITED CONCORDIA