Organization
OWENSBORO CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM DOUGLAS SHAVER D.M.D. (OWNER)
(270) 926-6100
Entity
Organization
Contact information
Practice address
2816 VEACH RD, OWENSBORO, KY 42303-6295
(270) 926-6100
(270) 926-6195
Mailing address
2816 VEACH RD, OWENSBORO, KY 42303-6295
(270) 926-6100
(270) 926-6195
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4637
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033220280
NPI
—
05
—
64046378
—
KY
Enumeration date
08/06/2009
Last updated
08/06/2009
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