| Gary R Shaw Dds | |
|
4103 Bridgeport Way W Suite A University Place WA 98466 | |
| (253) 565-4474 | |
| (253) 565-6848 |
| Full Name | Gary R Shaw Dds |
|---|---|
| Speciality | Dentist |
| Location | 4103 Bridgeport Way W, University Place, Washington |
| Authorized Official Name and Position | Gary R Shaw (DENTIST OWNER) |
| Authorized Official Contact | 2535654474 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary R Shaw Dds 4103 Bridgeport Way W Suite A University Place WA 98466 Ph: (253) 565-4474 | Gary R Shaw Dds 4103 Bridgeport Way W Suite A University Place WA 98466 Ph: (253) 565-4474 |
| NPI Number | 1265535652 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 10/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265535652 | NPI | - | NPPES |
| 601484620 | Other | WA | WASTEMPLOYMENT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DE00006436 (Washington) | Primary |
| 122300000X | Dentist | 1431549922 (Utah) | Secondary |
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