Provider Demographics
NPI:1619207107
Name:SHAW, RYAN (DMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PACIFIC AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2138
Mailing Address - Country:US
Mailing Address - Phone:724-224-0790
Mailing Address - Fax:724-224-2136
Practice Address - Street 1:1600 PACIFIC AVE STE 1
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2138
Practice Address - Country:US
Practice Address - Phone:724-224-0790
Practice Address - Fax:724-224-2136
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0378211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry