Organization
GLEN CREEK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES E SHELTON DMD (OWNER)
(503) 581-1142
Entity
Organization
Contact information
Practice address
470 GLEN CREEK RD NW, SUITE 100, SALEM, OR 97304-3060
(503) 581-1142
(503) 581-4809
Mailing address
470 GLEN CREEK RD NW, SUITE 100, SALEM, OR 97304-3060
(503) 581-1142
(503) 581-4809
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710965611
INDIVIDUAL
OR
Enumeration date
06/20/2007
Last updated
08/22/2020
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