Healthcare Provider Details

I. General information

NPI: 1326606104
Provider Name (Legal Business Name): SHELBY GRACE CAMP DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 OAK HARBOR BLVD
SLIDELL LA
70458-8817
US

IV. Provider business mailing address

6846 MARSHAL FOCH ST
NEW ORLEANS LA
70124-4033
US

V. Phone/Fax

Practice location:
  • Phone: 985-238-4234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858352
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number009629114
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: