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General NPI Number Information
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NPI Number | 1679869895
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Entity Type | Individual
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Provider Name | KACIE SHELTON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3131 BRIARPARK DR STE 102
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City | HOUSTON
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State | TX
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Zip | 77042-3792
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Country | US
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Telephone | 713-244-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 BRIARPARK DR STE 102
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City | HOUSTON
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State | TX
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Zip | 77042-3792
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Country | US
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Telephone | 713-244-0100
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 27109
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License Number State | TX
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