Provider Demographics
NPI:1326163312
Name:SHAW, PATRICIA CAROLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:CAROLE
Last Name:SHAW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MCGREGOR PT
Mailing Address - Street 2:
Mailing Address - City:ALBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05440-4004
Mailing Address - Country:US
Mailing Address - Phone:802-524-2779
Mailing Address - Fax:802-524-6587
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFORD
Practice Address - State:VT
Practice Address - Zip Code:05476-1151
Practice Address - Country:US
Practice Address - Phone:802-848-3829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice