Provider Demographics
NPI:1457806085
Name:ROBERT R. SHAW D.M.D.
Entity Type:Organization
Organization Name:ROBERT R. SHAW D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-747-8779
Mailing Address - Street 1:2700 S SOUTHEAST BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4984
Mailing Address - Country:US
Mailing Address - Phone:509-747-8779
Mailing Address - Fax:
Practice Address - Street 1:2700 S SOUTHEAST BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4984
Practice Address - Country:US
Practice Address - Phone:509-747-8779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5617261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental