Provider Demographics
NPI:1558361691
Name:SHAW, HARRY (DDS)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:SHAW
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 1:9961 VALLEY BLVD
Mailing Address - Street 2:SUITE # E
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1053
Mailing Address - Country:US
Mailing Address - Phone:626-442-8025
Mailing Address - Fax:626-442-8070
Practice Address - Street 1:2001 SANTA ANITA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3442
Practice Address - Country:US
Practice Address - Phone:626-443-3915
Practice Address - Fax:626-444-2086
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice