Provider Demographics
NPI:1447092838
Name:SHELTON, BRIAN ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALLEN
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 1:6231 N UTAH AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1373
Mailing Address - Country:US
Mailing Address - Phone:918-857-6778
Mailing Address - Fax:
Practice Address - Street 1:820 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6767
Practice Address - Country:US
Practice Address - Phone:405-577-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty