Provider Demographics
NPI:1578858015
Name:SHAW, NATHANAEL STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:STEPHEN
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 1:5000 HIGHWAY 49 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8465
Mailing Address - Country:US
Mailing Address - Phone:704-455-3333
Mailing Address - Fax:
Practice Address - Street 1:5000 HIGHWAY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8465
Practice Address - Country:US
Practice Address - Phone:704-455-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry