MEDICARE: DR. SHELBY NELSON D.D.S., M.S.

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	122300000X	Dentist	24664	TX
2	1223P0300X	Periodontics	24664	TX

General Provider Information

NPI Number	:	1528290426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELBY NELSON D.D.S., M.S.

Provider Business Mailing Address
First Line	:	3833 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3355
Country	:	US
Telephone Number	:	817-738-2334
Fax Number	:	817-738-1242

Provider Business Practice Location Address
First Line	:	3833 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3355
Country	:	US
Telephone Number	:	817-738-2334
Fax Number	:	817-738-1242

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

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	06/26/2024

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