Provider Demographics
NPI:1962830646
Name:SHELBY DENTAL CENTER
Entity Type:Organization
Organization Name:SHELBY DENTAL CENTER
Other - Org Name:SHELBY DENTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-664-1190
Mailing Address - Street 1:P O BOX 1105
Mailing Address - Street 2:101 HWY 87, BLDG
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-7209
Mailing Address - Country:US
Mailing Address - Phone:205-664-1190
Mailing Address - Fax:205-621-6212
Practice Address - Street 1:101 HIGHWAY 87
Practice Address - Street 2:BLDG 300
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-7209
Practice Address - Country:US
Practice Address - Phone:205-664-1190
Practice Address - Fax:205-621-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty