MEDICARE: THE WICKTON TEAM, LLC

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1619602299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WICKTON TEAM, LLC

Provider Business Mailing Address
First Line	:	1557 WINDVIEW
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-7641
Country	:	US
Telephone Number	:	502-314-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 PATRICK PL STE E
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-2110
Country	:	US
Telephone Number	:	502-314-3330
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREA CHADWICK SHELTON
Credential	:	DMD, MSD
Telephone Number	:	502-314-3330

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	07/19/2022

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Directions to “THE WICKTON TEAM, LLC ” Practice Location

Language	Start Address	Practice Location

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