Provider Demographics
NPI:1992004170
Name:SHAW, PATRICIA N (IPDH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:N
Last Name:SHAW
Suffix:
Gender:F
Credentials:IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 KING HILL RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ME
Mailing Address - Zip Code:04055-3315
Mailing Address - Country:US
Mailing Address - Phone:207-787-2939
Mailing Address - Fax:
Practice Address - Street 1:92 KING HILL RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:ME
Practice Address - Zip Code:04055-3315
Practice Address - Country:US
Practice Address - Phone:207-787-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME38124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist