# SHELTON ORAL SURGERY PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417083106
- **Authorized official:** MRS. MARIA SHELTON (MANAGER)
- **Authorized official phone:** (973) 621-6678

## Contact information

- **Practice address:** 573 MARTIN LUTHER KING BLVD, NEWARK, NJ 07102
- **Practice address phone:** (973) 621-6678
- **Practice address fax:** (973) 622-1710
- **Mailing address:** 573 MARTIN LUTHER KING BLVD, NEWARK, NJ 07102
- **Mailing address phone:** (973) 621-6678
- **Mailing address fax:** (973) 622-1710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 08689 | NJ | Yes |

## Other

- **Enumeration date:** 02/26/2007
- **Last updated:** 09/25/2007