Individual
KELLY SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1151 WASHINGTON ST, NEWELL, WV 26050-1437
(304) 459-4010
Mailing address
1305 DAIRY LN APT A, EAST LIVERPOOL, OH 43920-9766
(304) 680-0735
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4352
WV
Other
Enumeration date
07/11/2018
Last updated
04/25/2024
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