Provider Demographics
NPI:1649388463
Name:SHACKELFORD, JAMES MURRAY (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MURRAY
Last Name:SHACKELFORD
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 1:5111 HECKMAN WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9734
Mailing Address - Country:US
Mailing Address - Phone:317-889-7279
Mailing Address - Fax:
Practice Address - Street 1:3838 N RURAL ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2930
Practice Address - Country:US
Practice Address - Phone:317-221-2306
Practice Address - Fax:317-221-2336
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008755A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice