MEDICARE: JULIETTE SHELTON

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	124Q00000X	Dental Hygienist	7728	TX

General Provider Information

NPI Number	:	1417267667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIETTE SHELTON

Provider Business Mailing Address
First Line	:	1802 STONEY BROOK DR APT 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 BERING DR
Second Line	:	SUITE 650
City	:	HOUSTON
State	:	TX
Zip	:	77057-3151
Country	:	US
Telephone Number	:	713-784-2952
Fax Number	:

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

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	10/20/2010

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Directions to “ JULIETTE SHELTON ” Practice Location

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