Provider Demographics
NPI:1467657320
Name:SHELTON, ELIZABETH G (DDS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:SHELTON
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 1:902 N SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-4048
Mailing Address - Country:US
Mailing Address - Phone:361-358-3384
Mailing Address - Fax:361-358-5199
Practice Address - Street 1:902 N SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-4048
Practice Address - Country:US
Practice Address - Phone:361-358-3384
Practice Address - Fax:361-358-5199
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143473004Medicaid