Individual
KIN W SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
920 FREDERICA STREET, SUITE 301, OWENSBORO, KY 42301
(270) 926-7272
(270) 926-2699
Mailing address
3014 AUTUMN LAKE COVE, OWENSBORO, KY 42303
(270) 993-4270
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7760
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60001476
—
KY
Enumeration date
10/31/2006
Last updated
07/08/2007
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