Provider Demographics
NPI:1134291198
Name:SHELTON, GORDON BURTON (DMD PA)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:BURTON
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GREENWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-337-8838
Mailing Address - Fax:
Practice Address - Street 1:7402 YORK ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7522
Practice Address - Country:US
Practice Address - Phone:410-321-1133
Practice Address - Fax:410-321-0652
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5801Medicare UPIN