# SHELTON DENTAL PA

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

## Provider details

- **NPI number:** 1487840070
- **Authorized official:** MR. GODFREY P SHELTON D.M.D. (OWNER)
- **Authorized official phone:** (973) 622-3614

## Contact information

- **Practice address:** 573 MARTIN LUTHER KING JR BLVD, NEWARK, NJ 07102-1215
- **Practice address phone:** (973) 622-3614
- **Practice address fax:** (973) 792-0820
- **Mailing address:** 192 PROSPECT AVE, MAYWOOD, NJ 07607-1200
- **Mailing address phone:** (973) 622-3614
- **Mailing address fax:** (973) 792-0820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DI10706 | NJ | Yes |

## Other

- **Enumeration date:** 09/18/2007
- **Last updated:** 03/13/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2639700 | — | NJ |