Provider Demographics
NPI:1518022862
Name:SHAW, RACHELLE L (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:L
Last Name:SHAW
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Gender:F
Credentials:DDS PC
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Mailing Address - Street 1:4620 JEFFERSON LANE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-888-3520
Mailing Address - Fax:505-888-6553
Practice Address - Street 1:4620 JEFFERSON LANE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-888-3520
Practice Address - Fax:505-888-6553
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NM14531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry