Individual
LEE STEPHEN SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
27515 S. 4410 RD., VINITA, OK 74301
(918) 256-4800
(918) 258-4586
Mailing address
27515 S. 4410 RD., VINITA, OK 74301
(918) 256-4800
(918) 258-4586
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6569
OK
1223G0001X
General Practice Dentistry
2004032896
MO
1223G0001X
General Practice Dentistry
35652
CA
Other
Enumeration date
01/25/2012
Last updated
03/19/2015
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