Provider Demographics
NPI:1235426149
Name:SHAW, ALAN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1718
Mailing Address - Country:US
Mailing Address - Phone:714-841-4954
Mailing Address - Fax:714-841-4964
Practice Address - Street 1:18800 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1718
Practice Address - Country:US
Practice Address - Phone:714-841-4954
Practice Address - Fax:714-841-4964
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623911223S0112X
NC1508441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery