Provider Demographics
NPI:1184779308
Name:SHELTON, LEONARD STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:STANLEY
Last Name:SHELTON
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 1:8522 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217
Mailing Address - Country:US
Mailing Address - Phone:210-590-7878
Mailing Address - Fax:210-590-2966
Practice Address - Street 1:8522 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:210-590-7878
Practice Address - Fax:210-590-2966
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice