Provider Demographics
NPI:1811977598
Name:SHELTON, GODFREY P (DMD)
Entity type:Individual
Prefix:DR
First Name:GODFREY
Middle Name:P
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1200
Mailing Address - Country:US
Mailing Address - Phone:201-843-5344
Mailing Address - Fax:973-792-0820
Practice Address - Street 1:573 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1215
Practice Address - Country:US
Practice Address - Phone:973-622-3614
Practice Address - Fax:973-792-0820
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI107061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1281101Medicaid