Provider Demographics
NPI:1639344732
Name:DR. EDWARD G. SHAIVITZ D.D.S., P.A.
Entity type:Organization
Organization Name:DR. EDWARD G. SHAIVITZ D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:SHAIVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-490-5555
Mailing Address - Street 1:14333 LAUREL BOWIE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1126
Mailing Address - Country:US
Mailing Address - Phone:301-490-5555
Mailing Address - Fax:
Practice Address - Street 1:14333 LAUREL BOWIE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1126
Practice Address - Country:US
Practice Address - Phone:301-490-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52361223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty