Provider Demographics
NPI:1205588274
Name:ROSETTA SHELBY-CALVIN, DMD, P.A.
Entity type:Organization
Organization Name:ROSETTA SHELBY-CALVIN, DMD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBY-CALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:877-097-6743
Mailing Address - Street 1:10912 COLONEL GLENN RD STE 3500
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8241
Mailing Address - Country:US
Mailing Address - Phone:877-297-6743
Mailing Address - Fax:
Practice Address - Street 1:10912 COLONEL GLENN RD STE 3500
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8241
Practice Address - Country:US
Practice Address - Phone:877-297-6743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty