Provider Demographics
NPI:1720181712
Name:SHELTON, DENESE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENESE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SURREY PARK PL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-2622
Mailing Address - Country:US
Mailing Address - Phone:770-431-9043
Mailing Address - Fax:770-942-4859
Practice Address - Street 1:8415 CAMPBELLTON ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1876
Practice Address - Country:US
Practice Address - Phone:770-942-4899
Practice Address - Fax:770-942-4899
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist