Provider Demographics
NPI:1750470936
Name:SHAW, MICHAEL P (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
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 1:4901 LEGENDS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5800
Mailing Address - Country:US
Mailing Address - Phone:785-841-8894
Mailing Address - Fax:785-841-6480
Practice Address - Street 1:4901 LEGENDS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5800
Practice Address - Country:US
Practice Address - Phone:785-841-8894
Practice Address - Fax:785-841-6480
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS600301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice