Provider Demographics
NPI:1669026555
Name:DR. SHELBY NELSON DDS, LLC
Entity Type:Organization
Organization Name:DR. SHELBY NELSON DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-454-3816
Mailing Address - Street 1:3833 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3355
Mailing Address - Country:US
Mailing Address - Phone:817-738-2334
Mailing Address - Fax:
Practice Address - Street 1:3833 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3355
Practice Address - Country:US
Practice Address - Phone:817-738-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental