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Individual

KYLE ANDREW SHACKELFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RDH

Contact information

Practice address
6165 VALLEY SPRINGS PKWY STE E, RIVERSIDE, CA 92507-0955
(951) 214-6585
Mailing address
1301 W HEALD AVE, LAKE ELSINORE, CA 92530-3207
(951) 837-6092

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
32608
CA

Other

Enumeration date
02/11/2019
Last updated
02/11/2019
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