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General NPI Number Information
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NPI Number | 1427151059
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Entity Type | Organization
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Legal Business Name | ANGELA R SHELTON DMD PSC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 299 WEST LINCOLN TRAIL BLVD SUITE 102
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City | RADCLIFF
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State | KY
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Zip | 40160
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Country | US
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Telephone | 270-352-5566
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Fax | 270-352-5602
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Provider Business Mailing Address
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Address Line | PO BOX 778
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City | RADCLIFF
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State | KY
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Zip | 40159-0778
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Country | US
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Telephone | 270-352-5566
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Fax | 270-352-5602
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. ANGELA R SHELTON
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Credential | DMD
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Telephone | 270-352-5566
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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 | 7521
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License Number State | KY
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