Provider Demographics
NPI:1295735603
Name:SHAW, HARRY ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ROBERT
Last Name:SHAW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7147 SECURITY BLVD
Mailing Address - Street 2:SUITE 100 BOULEVARD PLACE
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1811
Mailing Address - Country:US
Mailing Address - Phone:410-298-8787
Mailing Address - Fax:410-298-0146
Practice Address - Street 1:7147 SECURITY BLVD
Practice Address - Street 2:SUITE 100 BOULEVARD PLACE
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1811
Practice Address - Country:US
Practice Address - Phone:410-298-8787
Practice Address - Fax:410-298-0146
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD56151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
124148OtherEHP, JH HEALTHCARE LLC
173281OtherUNITED CONCORDIA HONORS
MD5775OtherBLUE CROSS / BLUE SHIELD
95695OtherDENTAL BENEFIT PROVIDERS
838342OtherTRICARE ACTIVE DUTY
MD0101612OtherMONTGOMERY WARD ENTERPRIS
T77296Medicare UPIN
173281OtherUNITED CONCORDIA HONORS