Provider Demographics
NPI:1194940817
Name:TAULTON, SHIRLEY ANN (DDS)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:TAULTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 SOUTH HAMPTON RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232
Mailing Address - Country:US
Mailing Address - Phone:214-943-1311
Mailing Address - Fax:214-943-5125
Practice Address - Street 1:4650 SOUTH HAMPTON RD.
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232
Practice Address - Country:US
Practice Address - Phone:214-943-1311
Practice Address - Fax:214-943-5125
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD14702OtherBLUE CROSS BLUE SHIELD
TX47973OtherUNITED CONCORDIA