Healthcare Provider Details

I. General information

NPI: 1366010415
Provider Name (Legal Business Name): JACOB SHELTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13591 GRANT ST
THORNTON CO
80241-1131
US

IV. Provider business mailing address

13591 GRANT ST
THORNTON CO
80241-1131
US

V. Phone/Fax

Practice location:
  • Phone: 918-810-5645
  • Fax:
Mailing address:
  • Phone: 918-810-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number206029
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: