Provider Demographics
NPI:1659395648
Name:SHELTON, WILLIAM E (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:SHELTON
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 1:1985 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR823067OtherUNITED CONCORDIA IN
AL52015485OtherBLUE CROSS BLUE SHIELD AL
AR58273OtherAR BLUE CROSS BLUE SHIELD
TN4110809OtherBLUE CROSS BLUE SHIELD TN