Active NPI
Daniel J Shelby, DMD
- Periodontics
- Johnson City, TN
National Provider Identifier
1306093133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 10688
- Practice address
- 400 E Watauga Ave
Johnson City, TN 37601 - Phone
- (423) 926-4867
- NPI assigned
- Aug 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2328 | MT | |
| Periodontics | 1223P0300X | 10688 | TN | Primary |
Addresses
Primary practice location
400 E Watauga Ave
Johnson City, TN 37601
Mailing address
400 E Watauga Ave
Johnson City, TN 37601-4079
Phone (423) 926-4867
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2328 | MT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528156800000",
"number": "1306093133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E WATAUGA AVE",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376014079",
"telephone_number": "423-926-4867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E WATAUGA AVE",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "37601",
"telephone_number": "423-926-4867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELBY",
"first_name": "DANIEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-22",
"last_updated": "2018-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MT",
"license": "2328",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TN",
"license": "10688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.