Provider Demographics
NPI:1760779268
Name:JON E. SHELL D.D.S.
Entity Type:Organization
Organization Name:JON E. SHELL D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-429-4333
Mailing Address - Street 1:1106 GLENNHILL LN
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-6915
Mailing Address - Country:US
Mailing Address - Phone:865-429-4333
Mailing Address - Fax:865-429-2969
Practice Address - Street 1:1106 GLENNHILL LN
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6915
Practice Address - Country:US
Practice Address - Phone:865-429-4333
Practice Address - Fax:865-429-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS002876261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental