Healthcare Provider Details

I. General information

NPI: 1124916481
Provider Name (Legal Business Name): HENNY JOSEPH SHELTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 N MIAMI AVE
MIAMI FL
33127-3718
US

IV. Provider business mailing address

3930 PARADISE RD UNIT 377
LAS VEGAS NV
89169-4818
US

V. Phone/Fax

Practice location:
  • Phone: 786-724-0418
  • Fax:
Mailing address:
  • Phone: 504-352-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32519
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: