Provider Demographics
NPI:1558582726
Name:E. CARL SHAW, DMD, PC
Entity Type:Organization
Organization Name:E. CARL SHAW, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:E.
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-923-0253
Mailing Address - Street 1:1267 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5582
Mailing Address - Country:US
Mailing Address - Phone:478-923-0253
Mailing Address - Fax:
Practice Address - Street 1:1267 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5582
Practice Address - Country:US
Practice Address - Phone:478-923-0253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty