Individual
DR. SHELTON PARK MIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4101 BALMORAL DR SW, SUITE B, HUNTSVILLE, AL 35801-6409
(256) 880-6556
(256) 880-2945
Mailing address
4101 BALMORAL DR SW, SUITE B, HUNTSVILLE, AL 35801-6409
(256) 880-6556
(256) 880-2945
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
3879
AL
Other
Enumeration date
05/21/2007
Last updated
05/21/2012
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