Provider Demographics
NPI:1750362125
Name:SHELTON, CHARLES SYLVESTER (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SYLVESTER
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-542-6900
Mailing Address - Fax:410-542-6907
Practice Address - Street 1:5418 PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-542-6900
Practice Address - Fax:410-542-6907
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist