Provider Demographics
NPI:1528290426
Name:NELSON, SHELBY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3355
Mailing Address - Country:US
Mailing Address - Phone:817-738-2334
Mailing Address - Fax:817-738-1242
Practice Address - Street 1:3833 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3355
Practice Address - Country:US
Practice Address - Phone:817-738-2334
Practice Address - Fax:817-738-1242
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24664122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist