Healthcare Provider Details

I. General information

NPI: 1720169808
Provider Name (Legal Business Name): DR. JAMES M SHELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SW 7 TH ST
LINDSAY OK
73052
US

IV. Provider business mailing address

407 OLIVE BLVD
LINDSAY OK
73052-2214
US

V. Phone/Fax

Practice location:
  • Phone: 405-756-4093
  • Fax: 405-756-4093
Mailing address:
  • Phone: 405-756-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5888
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: