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General NPI Number Information
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NPI Number | 1073593992
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Entity Type | Individual
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Provider Name | SHELLY L. MCCOLM D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12 W 8TH ST
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City | LAWRENCE
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State | KS
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Zip | 66044-2602
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Country | US
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Telephone | 785-832-0809
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 INGE CT
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City | LAWRENCE
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State | KS
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Zip | 66049-4835
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Country | US
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Telephone | 785-832-1782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | KS7061
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License Number State | KS
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