Provider Demographics
NPI:1083092571
Name:SHAW, RACHEL KARA JOLLEY (DMD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:KARA JOLLEY
Last Name:SHAW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 W HIGHWAY 82 STE 101
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2535
Mailing Address - Country:US
Mailing Address - Phone:940-665-1571
Mailing Address - Fax:
Practice Address - Street 1:834 W HIGHWAY 82 STE 101
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2535
Practice Address - Country:US
Practice Address - Phone:940-665-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX380951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice