| NPI | 1992149306 |
|---|---|
| Other Name | SHAD HATTAWAY |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30158) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-023996) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2015-12-16 |