Provider Demographics
NPI:1114068277
Name:SHAW, STEVEN SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SCOTT
Last Name:SHAW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4609
Mailing Address - Country:US
Mailing Address - Phone:207-329-0023
Mailing Address - Fax:
Practice Address - Street 1:163 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3242
Practice Address - Country:US
Practice Address - Phone:207-773-3794
Practice Address - Fax:207-772-1011
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME35471223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice