Individual
DR. KRISAN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
501 W. LUCAS LANE, ELLSWORTH, WI 54011
(715) 273-3700
(715) 273-1700
Mailing address
PO BOX 310, 501 W. LUCAS LANE, ELLSWORTH, WI 54011
(715) 273-3700
(715) 273-1700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5175-015
WI
Other
Enumeration date
03/06/2007
Last updated
03/18/2014
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