Provider Demographics
NPI:1912013228
Name:SHELTON, BEAUMONT LAWSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEAUMONT
Middle Name:LAWSON
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WEST COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5555
Mailing Address - Country:US
Mailing Address - Phone:256-767-1111
Mailing Address - Fax:256-767-1117
Practice Address - Street 1:313 WEST COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5555
Practice Address - Country:US
Practice Address - Phone:256-767-1111
Practice Address - Fax:256-767-1117
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLNO38961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
U12084Medicare UPIN