MEDICARE: JAMES S SHELBY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7654	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4025322	OTHER	PA	UNITED CONCORDIA
2	5025127	OTHER	WA	DSHS

General Provider Information

NPI Number	:	1104912278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES S SHELBY D.D.S.

Provider Business Mailing Address
First Line	:	3233 W INDIAN TRAIL RD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-4761
Country	:	US
Telephone Number	:	509-326-5454
Fax Number	:	509-326-0314

Provider Business Practice Location Address
First Line	:	3233 W INDIAN TRAIL RD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-4761
Country	:	US
Telephone Number	:	509-326-5454
Fax Number	:	509-326-0314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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