1821108408 NPI number — ERIN AMANDA SHELTON-SPARKS DDS

Table of content: ERIN AMANDA SHELTON-SPARKS DDS (NPI 1821108408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821108408 NPI number — ERIN AMANDA SHELTON-SPARKS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELTON-SPARKS
Provider First Name:
ERIN
Provider Middle Name:
AMANDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHELTON
Provider Other First Name:
ERIN
Provider Other Middle Name:
AMANDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821108408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1694 HOLLAND
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-894-4004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E THIRD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVISON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-653-2212
Provider Business Practice Location Address Fax Number:
810-658-4330
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901018403 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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