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General NPI Number Information
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NPI Number | 1326106113
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Entity Type | Organization
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Legal Business Name | SHEL DENTAL CENTER
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2257 JACKSBORO PIKE
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City | LA FOLLETTE
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State | TN
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Zip | 37766-2904
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Country | US
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Telephone | 423-562-4766
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Fax | 423-562-3998
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Provider Business Mailing Address
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Address Line | 2257 JACKSBORO PIKE
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City | LA FOLLETTE
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State | TN
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Zip | 37766-2904
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Country | US
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Telephone | 423-562-4766
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Fax | 423-562-3998
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDDIE C TOWLES
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Credential |
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Telephone | 423-562-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS2996
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License Number State | TN
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