Provider Demographics
NPI:1700882784
Name:SMITH, SHELBY J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:J
Last Name:SMITH
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:2213 BUCHANAN RD
Mailing Address - Street 2:STE 112
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4265
Mailing Address - Country:US
Mailing Address - Phone:925-755-5115
Mailing Address - Fax:925-755-5003
Practice Address - Street 1:2213 BUCHANAN RD
Practice Address - Street 2:STE 112
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4265
Practice Address - Country:US
Practice Address - Phone:925-755-5115
Practice Address - Fax:925-755-5003
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA384821223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics