Provider Demographics
NPI:1942795216
Name:SANFORD, SHELLEY RENE (DDS)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENE
Last Name:SANFORD
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 1:2501 CRESTWOOD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7615
Mailing Address - Country:US
Mailing Address - Phone:501-758-3393
Mailing Address - Fax:501-758-4346
Practice Address - Street 1:2501 CRESTWOOD RD STE 103
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7615
Practice Address - Country:US
Practice Address - Phone:501-758-3393
Practice Address - Fax:501-758-4346
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist