Individual
KEITH BILLINGS SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4324 COVINGTON HWY, DECATUR, GA 30035-1208
(404) 289-6454
Mailing address
2945 ROSEBUD RD, #420, LOGANVILLE, GA 30052-8947
(208) 709-8782
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN014607
GA
1223G0001X
General Practice Dentistry
Primary
DN014607
GA
Other
Enumeration date
06/27/2013
Last updated
06/27/2013
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