Provider Demographics
NPI:1255334231
Name:SHELBURNE, LYNN ELLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ELLEN
Last Name:SHELBURNE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-9009
Mailing Address - Country:US
Mailing Address - Phone:502-902-6120
Mailing Address - Fax:
Practice Address - Street 1:1477 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-9009
Practice Address - Country:US
Practice Address - Phone:502-477-8792
Practice Address - Fax:502-477-8792
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY61011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice