# SHAW & WIEDERHOLD PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184998866
- **Authorized official:** DR. KIN W SHAW DMD (PRESIDENT)
- **Authorized official phone:** (270) 926-7272

## Contact information

- **Practice address:** 920 FREDERICA ST, 301, OWENSBORO, KY 42301-3050
- **Practice address phone:** (270) 926-7272
- **Mailing address:** 920 FREDERICA ST, 301, OWENSBORO, KY 42301-3050
- **Mailing address phone:** (270) 926-7272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7760 | KY | Yes |

## Other

- **Enumeration date:** 02/28/2012
- **Last updated:** 02/28/2012