Provider Demographics
NPI:1043706799
Name:SHAW, JOSHUA JOSEPH
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOSEPH
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17081 W GREENWAY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-9612
Mailing Address - Country:US
Mailing Address - Phone:623-546-8400
Mailing Address - Fax:
Practice Address - Street 1:17081 W GREENWAY RD STE 120
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-9612
Practice Address - Country:US
Practice Address - Phone:623-546-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0100921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice