Provider Demographics
NPI:1881930014
Name:SHELLEY, JEFFREY ALBERT JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALBERT
Last Name:SHELLEY
Suffix:JR
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 1:379 CHEWACLA DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5565
Mailing Address - Country:US
Mailing Address - Phone:334-549-1785
Mailing Address - Fax:
Practice Address - Street 1:1957 E SAMFORD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830
Practice Address - Country:US
Practice Address - Phone:335-521-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-16
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0151251223G0001X
ALD.0005951-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice