Individual
JUSTIN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
220 SOUTHLAND DR, SIKESTON, MO 63801-4403
(573) 471-4167
(573) 471-4212
Mailing address
6738 STATE HIGHWAY 77, BENTON, MO 63736-8238
(573) 545-4200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2025035974
MO
Other
Enumeration date
06/05/2023
Last updated
08/27/2025
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