Provider Demographics
NPI:1972014744
Name:SHELTON DENTAL GROUP LLC
Entity Type:Organization
Organization Name:SHELTON DENTAL GROUP LLC
Other - Org Name:SHELTON DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:YADVERINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-595-8388
Mailing Address - Street 1:169 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3241
Mailing Address - Country:US
Mailing Address - Phone:203-925-9425
Mailing Address - Fax:203-922-9322
Practice Address - Street 1:169 CENTER ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3241
Practice Address - Country:US
Practice Address - Phone:203-925-9425
Practice Address - Fax:203-922-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty