MEDICARE: DR. KACIE SHELTON D.D.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	1223P0221X	Pediatric Dentistry	27109	TX

General Provider Information

NPI Number	:	1679869895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KACIE SHELTON D.D.S.

Provider Business Mailing Address
First Line	:	3131 BRIARPARK DR STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3792
Country	:	US
Telephone Number	:	713-244-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 BRIARPARK DR STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3792
Country	:	US
Telephone Number	:	713-244-0100
Fax Number	:

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	07/21/2022

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