Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 9284 | CO |
NPI | 1003966714 |
---|---|
Provider Name | Dr. Gary D. Sheldon |
First Address | Colorado Springs, CO 80909-8009 |
Second Address | Greeley, CO 80634-5368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 14/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54556775 | (05) | CO |
DEN.00009284 | CO DENTAL LICENSE (01) | CO |