Individual
ETHAN JOHN HOWARD SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2018 BROADWAY ST, PADUCAH, KY 42001-7108
(270) 443-9099
Mailing address
117 30TH AVE N APT 304, NASHVILLE, TN 37203-1395
(618) 638-3868
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11060
TN
Other
Enumeration date
06/03/2019
Last updated
10/01/2019
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