Provider Demographics
NPI:1952494858
Name:GREEN, SHELBY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:MARIE
Last Name:GREEN
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 1:6102 82ND ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424
Mailing Address - Country:UM
Mailing Address - Phone:806-799-8160
Mailing Address - Fax:806-799-7826
Practice Address - Street 1:6102 82ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0802
Practice Address - Country:US
Practice Address - Phone:806-799-8160
Practice Address - Fax:806-799-7826
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice