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General NPI Number Information
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NPI Number | 1366010415
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Entity Type | Individual
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Provider Name | JACOB SHELTON DDS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 150 E, OK-33
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City | PERKINS
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State | OK
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Zip | 74059
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Country | US
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Telephone | 405-939-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 5527 E 107TH PL
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City | TULSA
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State | OK
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Zip | 74137-7090
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Country | US
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Telephone | 918-810-5645
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7427
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License Number State | OK
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