Provider Demographics
NPI:1609217637
Name:CATLETT, SHELLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:CATLETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHELLY
Other - Middle Name:CATLETT
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:474 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1318
Mailing Address - Country:US
Mailing Address - Phone:803-245-5545
Mailing Address - Fax:
Practice Address - Street 1:474 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1318
Practice Address - Country:US
Practice Address - Phone:803-245-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30-08232OtherSOUTH CAROLINA CONTROLLED SUBSTANCES REGISTRATION #
SCZX8232Medicaid
SCFW4114714OtherDEA #