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General NPI Number Information
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NPI Number | 1366261810
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Entity Type | Individual
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Provider Name | CAROLINE SHELLEY DDS
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 415 N PACIFIC COAST HWY STE 100-A
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2840
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Country | US
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Telephone | 310-469-9353
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Fax |
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Provider Business Mailing Address
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Address Line | 340 THE VLG UNIT 104
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2624
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Country | US
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Telephone | 843-269-4208
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 110881
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License Number State | CA
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