Individual
STEPHANIE SHACKELFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
3340 LONGMEADE DR, DALLAS, TX 75234-3748
(214) 995-9761
Mailing address
3340 LONGMEADE DR, DALLAS, TX 75234-3748
(214) 995-9761
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
14103
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14103
REGISTERED DENTAL HYGIENIST
TX
Enumeration date
09/26/2021
Last updated
09/26/2021
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