Organization
SHELTON DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GODFREY P SHELTON D.M.D. (OWNER)
(973) 622-3614
Entity
Organization
Contact information
Practice address
573 MARTIN LUTHER KING JR BLVD, NEWARK, NJ 07102-1215
(973) 622-3614
(973) 792-0820
Mailing address
192 PROSPECT AVE, MAYWOOD, NJ 07607-1200
(973) 622-3614
(973) 792-0820
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DI10706
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2639700
—
NJ
Enumeration date
09/18/2007
Last updated
03/13/2012
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