Provider Demographics
NPI:1962751149
Name:SHELTON, MEGAN NICOLE SEAY (DMD)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLE SEAY
Last Name:SHELTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 INTEGRITY DRIVE BUILDING S-771
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38054
Mailing Address - Country:US
Mailing Address - Phone:901-874-6185
Mailing Address - Fax:
Practice Address - Street 1:5722 INTEGRITY DRIVE BUILDING S-771
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054
Practice Address - Country:US
Practice Address - Phone:901-874-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY92221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice