Individual
DR. SHANE RADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2925 NAIL RD E STE 2, SOUTHAVEN, MS 38672-6707
(662) 536-3661
Mailing address
1356 SAINT CLAIRE PARK, SOUTHAVEN, MS 38671-7040
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11860
TN
Other
Enumeration date
09/21/2022
Last updated
09/21/2022
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