MEDICARE: DR. COURTNEY W SHELBOURNE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	3426	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407857428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY W SHELBOURNE DMD

Provider Business Mailing Address
First Line	:	198 RUTLEDGE AVE
Second Line	:	SUITE 4
City	:	CHARLESTON
State	:	SC
Zip	:	29403-5817
Country	:	US
Telephone Number	:	843-853-5859
Fax Number	:	843-853-5861

Provider Business Practice Location Address
First Line	:	198 RUTLEDGE AVE
Second Line	:	SUITE 4
City	:	CHARLESTON
State	:	SC
Zip	:	29403-5817
Country	:	US
Telephone Number	:	843-853-5859
Fax Number	:	843-853-5861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/25/2013

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