Provider Demographics
NPI:1821561903
Name:ANGELA SHAW DDS INC
Entity Type:Organization
Organization Name:ANGELA SHAW DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-372-7858
Mailing Address - Street 1:1400 LAS PALMAS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7582
Mailing Address - Country:US
Mailing Address - Phone:714-525-2381
Mailing Address - Fax:714-525-2382
Practice Address - Street 1:1400 LAS PALMAS DR STE 1
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7582
Practice Address - Country:US
Practice Address - Phone:714-525-2381
Practice Address - Fax:714-525-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental