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General NPI Number Information
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NPI Number | 1346506201
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Entity Type | Individual
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Provider Name | JONATHAN JOSEPH SHELTON DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 6386 ALVARADO CT STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92120
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Country | US
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Telephone | 619-287-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 6386 ALVARADO CT STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92120-4906
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Country | US
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Telephone | 619-287-5000
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9172
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A153454
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | A153454
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License Number State | CA
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