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General NPI Number Information
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NPI Number | 1770943581
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Entity Type | Organization
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Legal Business Name | SD.SHELTON FAMILY DENTISTRY
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 1626 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2522
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Country | US
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Telephone | 931-728-0313
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Fax |
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Provider Business Mailing Address
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Address Line | 1626 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2522
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Country | US
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Telephone | 931-728-0313
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. PETER CRAIGUE SHELTON
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Credential | D.D.S.
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Telephone | 931-728-0313
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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 | DS4018
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License Number State | TN
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