Provider Demographics
NPI:1477052272
Name:SHAW FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:SHAW FAMILY DENTISTRY PLLC
Other - Org Name:U STREET FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YETUNDE
Authorized Official - Middle Name:IBIYEMI
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-900-9006
Mailing Address - Street 1:1515 U ST NW STE A1C1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3948
Mailing Address - Country:US
Mailing Address - Phone:202-900-9006
Mailing Address - Fax:
Practice Address - Street 1:1515 U STREET NW
Practice Address - Street 2:SUITE A1 C1
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20009
Practice Address - Country:US
Practice Address - Phone:202-900-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty