Provider Demographics
NPI:1104912278
Name:SHELBY, JAMES S (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:SHELBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4761
Mailing Address - Country:US
Mailing Address - Phone:509-326-5454
Mailing Address - Fax:509-326-0314
Practice Address - Street 1:3233 W INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4761
Practice Address - Country:US
Practice Address - Phone:509-326-5454
Practice Address - Fax:509-326-0314
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA76541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4025322OtherUNITED CONCORDIA
WA5025127OtherDSHS