Provider Demographics
NPI:1720169808
Name:SHELTON, JAMES M
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:SHELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-2214
Mailing Address - Country:US
Mailing Address - Phone:405-756-1465
Mailing Address - Fax:
Practice Address - Street 1:102 SW 7 TH ST
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052
Practice Address - Country:US
Practice Address - Phone:405-756-4093
Practice Address - Fax:405-756-4093
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice