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Individual
LEE STEPHEN SHACKELFORD
Active
Individual
LEE STEPHEN SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6569
OK
1223G0001X
General Practice Dentistry
2004032896
MO
1223G0001X
General Practice Dentistry
35652
CA
Other
Enumeration date
01/25/2012
Last updated
03/19/2015
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