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Organization

SHAW FAMILY DENTAL SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KRISAN SHAW (OWNER)
(715) 425-6081
Entity
Organization

Contact information

Practice address
501 W. LUCAS LANE, ELLSWORTH, WI 54011
(715) 273-3700
(715) 273-1700
Mailing address
501 W. LUCAS LANE, ELLSWORTH, WI 54011
(715) 273-3700
(715) 273-1700

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5175-015
WI

Other

Enumeration date
03/19/2014
Last updated
03/19/2014
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