Provider Demographics
NPI:1366261810
Name:SHELLEY, CAROLINE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:SHELLEY
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 1:340 THE VLG UNIT 104
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2624
Mailing Address - Country:US
Mailing Address - Phone:843-269-4208
Mailing Address - Fax:
Practice Address - Street 1:415 N PACIFIC COAST HWY STE 100-A
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2840
Practice Address - Country:US
Practice Address - Phone:310-469-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty