Individual
ANNELISE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
590 MEDICAL CENTER RD, APO, AA 76544-5060
(310) 989-0323
Mailing address
403 ROSEDALE BLVD, GEORGETOWN, TX 78628-4675
(310) 989-0323
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12913
TN
Other
Enumeration date
08/01/2025
Last updated
08/10/2026
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