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General NPI Number Information
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NPI Number | 1861936056
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Entity Type | Organization
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Legal Business Name | MEGAN A. SHELTON, D.M.D., DENTAL CORP.
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 3144 EL CAMINO REAL SUITE 103
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City | CARLSBAD
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State | CA
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Zip | 92008-2194
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Country | US
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Telephone | 760-434-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 3144 EL CAMINO REAL SUITE 103
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City | CARLSBAD
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State | CA
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Zip | 92008-2194
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Country | US
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Telephone | 760-434-9800
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Fax |
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | MEGAN SHELTON
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Credential | D.M.D.
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Telephone | 316-393-9162
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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 | 63304
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License Number State | CA
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