Healthcare Provider Details

I. General information

NPI: 1194940817
Provider Name (Legal Business Name): SHIRLEY ANN TAULTON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SOUTH HAMPTON RD. SUITE 103
DALLAS TX
75232
US

IV. Provider business mailing address

4650 SOUTH HAMPTON RD. SUITE 103
DALLAS TX
75232
US

V. Phone/Fax

Practice location:
  • Phone: 214-943-1311
  • Fax: 214-943-5125
Mailing address:
  • Phone: 214-943-1311
  • Fax: 214-943-5125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: