Individual
ANNELISE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2441 21ST ST, FORT CAMPBELL, KY 42223-5582
(270) 798-8751
Mailing address
820 S GATEWAY PLAZA BLVD UNIT 1401, CLARKSVILLE, TN 37043-2779
(310) 989-0323
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12913
TN
Other
Enumeration date
08/01/2025
Last updated
08/01/2025
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