Provider Demographics
NPI:1710965611
Name:SHELTON, JAMES EDWARD (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:GLEN
Other - Middle Name:CREEK
Other - Last Name:DENTAL LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLC
Mailing Address - Street 1:470 GLEN CREEK RD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3060
Mailing Address - Country:US
Mailing Address - Phone:503-581-1142
Mailing Address - Fax:
Practice Address - Street 1:470 GLEN CREEK RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3060
Practice Address - Country:US
Practice Address - Phone:503-581-1142
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist