MEDICARE: DR. ALAN GENE SHELHAMER 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	53163	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	18846	TX

General Provider Information

NPI Number	:	1578565081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN GENE SHELHAMER D.D.S.

Provider Business Mailing Address
First Line	:	6390 PASEO ASPADA
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-3011
Country	:	US
Telephone Number	:	619-987-8008
Fax Number	:	760-931-9981

Provider Business Practice Location Address
First Line	:	6221 METROPOLITAN ST
Second Line	:	SUITE #103
City	:	CARLSBAD
State	:	CA
Zip	:	92009-3096
Country	:	US
Telephone Number	:	619-987-8008
Fax Number	:	760-931-9981

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	11/19/2009

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