Shelley Orthodontics, LLC

Contacts

Phone	+1 334-521-0112

Authorized person

Name	DR. JEFFREY SHELLEY
Role	OWNER/ORTHODONTIST
Phone	3345491785

Taxonomy

Taxonomy Code	1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-01-01
Business code	621210
Sponsor’s telephone number	3345210112
Plan sponsor’s address	1957 E. SAMFORD AVE. STE A, AUBURN, AL, 36830

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-01-01
Business code	621210
Sponsor’s telephone number	3345210112
Plan sponsor’s address	1957 E. SAMFORD AVE. STE A, AUBURN, AL, 36830

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-01-01
Business code	621210
Sponsor’s telephone number	3345210112
Plan sponsor’s address	1957 E. SAMFORD AVE. STE A, AUBURN, AL, 36830

Signature of

Role	Plan administrator
Date	2022-04-05
Name of individual signing	JEFFREY SHELLEY