Provider Demographics
NPI:1750327599
Name:SHAW, RONALD KEVIN
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEVIN
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E 11400 S
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6942
Mailing Address - Country:US
Mailing Address - Phone:801-572-8955
Mailing Address - Fax:
Practice Address - Street 1:1025 E 11400 S
Practice Address - Street 2:SUITE #101
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-6942
Practice Address - Country:US
Practice Address - Phone:801-572-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1444671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice