Provider Demographics
NPI:1689288755
Name:SHELTON, INDI ARRINGTON (DDS)
Entity Type:Individual
Prefix:
First Name:INDI
Middle Name:ARRINGTON
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 1:701 EASLEY BRIDGE RD APT 30032
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-5157
Mailing Address - Country:US
Mailing Address - Phone:803-236-0973
Mailing Address - Fax:
Practice Address - Street 1:1904 MEHARRY BLVD # 3
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2900
Practice Address - Country:US
Practice Address - Phone:803-236-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 390200000X
SC101161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No171W00000XOther Service ProvidersContractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program