Provider Demographics
NPI:1447943352
Name:SHELL, SANDRA LYNN (RDH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:SHELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SLAGLE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-6649
Mailing Address - Country:US
Mailing Address - Phone:423-360-2563
Mailing Address - Fax:
Practice Address - Street 1:417 HUDSON DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2881
Practice Address - Country:US
Practice Address - Phone:423-543-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH0000004733124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist