Provider Demographics
NPI:1619050283
Name:SHUFFORD, EARL LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:LEWIS
Last Name:SHUFFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1320
Mailing Address - Country:US
Mailing Address - Phone:804-520-4092
Mailing Address - Fax:804-520-4093
Practice Address - Street 1:3524 BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1320
Practice Address - Country:US
Practice Address - Phone:804-520-4092
Practice Address - Fax:804-520-4093
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010079811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery