Provider Demographics
NPI:1821108408
Name:SHELTON-SPARKS, ERIN AMANDA (DDS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:AMANDA
Last Name:SHELTON-SPARKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:AMANDA
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1694 HOLLAND
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009
Mailing Address - Country:US
Mailing Address - Phone:248-894-4004
Mailing Address - Fax:
Practice Address - Street 1:110 E THIRD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423
Practice Address - Country:US
Practice Address - Phone:810-653-2212
Practice Address - Fax:810-658-4330
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist