Healthcare Provider Details

I. General information

NPI: 1649388463
Provider Name (Legal Business Name): JAMES MURRAY SHACKELFORD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N RURAL ST
INDIANAPOLIS IN
46205-2930
US

IV. Provider business mailing address

5111 HECKMAN WAY
GREENWOOD IN
46142-9734
US

V. Phone/Fax

Practice location:
  • Phone: 317-221-2306
  • Fax: 317-221-2336
Mailing address:
  • Phone: 317-889-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008755A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: