Provider Demographics
NPI:1902046758
Name:CHOW, SHELTON L (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELTON
Middle Name:L
Last Name:CHOW
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 1:75 E RIVULON BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0005
Mailing Address - Country:US
Mailing Address - Phone:520-886-8090
Mailing Address - Fax:520-886-8274
Practice Address - Street 1:75 E RIVULON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0005
Practice Address - Country:US
Practice Address - Phone:520-440-1856
Practice Address - Fax:520-886-8274
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ77191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice