Individual
MICAH SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
303 S BROAD ST, MONROE, GA 30655-2119
(770) 267-4404
Mailing address
303 S BROAD ST, MONROE, GA 30655-2119
(770) 267-4404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN014307
GA
Other
Enumeration date
07/07/2011
Last updated
06/22/2017
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