Individual
KIM SUE SHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5703 DENTON CIR, NORCROSS, GA 30092-2079
(770) 734-0045
Mailing address
5703 DENTON CIR, NORCROSS, GA 30092-2079
(770) 734-0045
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
1223X0400X
GA
Other
Enumeration date
01/09/2012
Last updated
01/09/2012
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