Provider Demographics
NPI:1124407234
Name:SHAW, ELY & DUBOS, D.D.S., INC.
Entity Type:Organization
Organization Name:SHAW, ELY & DUBOS, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-474-1900
Mailing Address - Street 1:1200 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9400
Mailing Address - Country:US
Mailing Address - Phone:740-474-1900
Mailing Address - Fax:740-474-3991
Practice Address - Street 1:1200 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9400
Practice Address - Country:US
Practice Address - Phone:740-474-1900
Practice Address - Fax:740-474-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024484261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental