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General NPI Number Information
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NPI Number | 1871724914
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Entity Type | Organization
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Legal Business Name | OWENSBORO CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 2816 VEACH RD
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City | OWENSBORO
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State | KY
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Zip | 42303-6295
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Country | US
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Telephone | 270-926-6100
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Fax | 270-926-6195
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Provider Business Mailing Address
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Address Line | 2816 VEACH RD
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City | OWENSBORO
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State | KY
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Zip | 42303-6295
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Country | US
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Telephone | 270-926-6100
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Fax | 270-926-6195
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM DOUGLAS SHAVER
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Credential | D.M.D.
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Telephone | 270-926-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4637
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License Number State | KY
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