Provider Demographics
NPI:1952315079
Name:SHELLEY, PETER QUINN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:QUINN
Last Name:SHELLEY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13605 XAVIER LANE
Mailing Address - Street 2:UNIT E
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-0000
Mailing Address - Country:US
Mailing Address - Phone:303-427-2769
Mailing Address - Fax:303-427-1782
Practice Address - Street 1:13605 XAVIER LANE
Practice Address - Street 2:UNIT E
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-0000
Practice Address - Country:US
Practice Address - Phone:303-427-2769
Practice Address - Fax:303-427-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-92281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics