Provider Demographics
NPI:1952330433
Name:SHAW, MARK ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:SHAW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1267 GILL HALL RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3406
Mailing Address - Country:US
Mailing Address - Phone:412-714-4838
Mailing Address - Fax:412-650-4105
Practice Address - Street 1:113 CURRY HOLLOW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLEASANT HILLS
Practice Address - State:PA
Practice Address - Zip Code:15236-4600
Practice Address - Country:US
Practice Address - Phone:412-650-4101
Practice Address - Fax:412-650-4105
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS028947L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice