Provider Demographics
NPI:1689876179
Name:SHAW, TROY R (DMD, MS, PC)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:R
Last Name:SHAW
Suffix:
Gender:M
Credentials:DMD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S RESERVE ST STE C
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4704
Mailing Address - Country:US
Mailing Address - Phone:406-327-0777
Mailing Address - Fax:406-327-8611
Practice Address - Street 1:1300 S RESERVE ST STE C
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4704
Practice Address - Country:US
Practice Address - Phone:406-327-0777
Practice Address - Fax:406-327-8611
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics