Individual
DR. THOMAS EDWARD SHAW III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2750 WATTS DR NW, KENNESAW, GA 30144-2721
(770) 429-0955
(770) 429-0219
Mailing address
371 HICKORY LAKE DR, ACWORTH, GA 30101-8753
(863) 660-2316
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN009589
GA
1223G0001X
General Practice Dentistry
DN9316
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003155301A
—
GA
05
—
004102800
—
FL
Enumeration date
01/09/2007
Last updated
03/23/2023
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