Talia Marie Shackelford, DDS

NPI #1922415223 in Fort Gratiot, Michigan

Provider Information

NPI Number: 1922415223
Entity Type: Individual
Name: Talia Marie Shackelford, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Jul 18, 2014
Last Updated: Jul 18, 2014

Practice Location

Address: 4216 24TH AVE
City: Fort Gratiot
State: Michigan
ZIP Code: 48059-3880
Phone: (810) 479-4821

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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