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Organization
RODERICK K SHAW III DMD PA
Active
Organization
RODERICK K SHAW III DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN B SHAW DM (VICE PRES)
(850) 973-6427
Entity
Organization
Contact information
Practice address
255 NE DUVAL AVE, MADISON, FL 32340
(850) 973-6427
(850) 973-9646
Mailing address
255 NE DUVAL AVE, MADISON, FL 32340
(850) 973-6427
(850) 973-9646
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN10977
FL
Other
Enumeration date
05/09/2007
Last updated
08/22/2020
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