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General NPI Number Information
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NPI Number | 1003926940
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Entity Type | Individual
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Provider Name | ROY S SHELBURNE DDS
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 14245 LEE HWY
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City | BRISTOL
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State | VA
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Zip | 24202-4317
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Country | US
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Telephone | 276-628-8164
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Fax |
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Provider Business Mailing Address
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Address Line | 37166 WILDERNESS RD
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City | JONESVILLE
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State | VA
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Zip | 24263-8085
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Country | US
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Telephone | 276-346-3863
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Fax | 276-346-3944
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401-005798
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License Number State | VA
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