Provider Demographics
NPI:1376670794
Name:SHEW, WALTER SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:SCOTT
Last Name:SHEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W CENTRAL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3373
Mailing Address - Country:US
Mailing Address - Phone:714-529-1311
Mailing Address - Fax:714-529-1489
Practice Address - Street 1:255 W CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3373
Practice Address - Country:US
Practice Address - Phone:714-529-1311
Practice Address - Fax:714-529-1489
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist