Provider Demographics
NPI:1831193200
Name:SHELTON, JEFFREY TAYLOR (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TAYLOR
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 1:705 E MARSHALL AVE
Mailing Address - Street 2:SUITE 4002
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5563
Mailing Address - Country:US
Mailing Address - Phone:903-315-3840
Mailing Address - Fax:903-315-1975
Practice Address - Street 1:705 E MARSHALL AVE
Practice Address - Street 2:SUITE 4002
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5563
Practice Address - Country:US
Practice Address - Phone:903-315-3840
Practice Address - Fax:903-315-1975
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice