MEDICARE: DR. JOHN L SHELTON DDS

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	122300000X	Dentist	DS8883	TN

General Provider Information

NPI Number	:	1265695027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN L SHELTON DDS

Provider Business Mailing Address
First Line	:	1626 MCARTHUR ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1626 MCARTHUR ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2522
Country	:	US
Telephone Number	:	931-728-0313
Fax Number	:

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

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/02/2008

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