Individual
DR. SHELLY L. MCCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
12 W 8TH ST, LAWRENCE, KS 66044-2602
(785) 832-0809
Mailing address
5005 INGE CT, LAWRENCE, KS 66049-4835
(785) 832-1782
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
KS7061
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KS7061
7061
KS
Enumeration date
01/18/2006
Last updated
07/08/2007
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