Provider Demographics
NPI:1871525485
Name:SHAW, ALLAN S (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:S
Last Name:SHAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE #1116
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-640-0811
Mailing Address - Fax:215-640-0912
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE #1116
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-640-0811
Practice Address - Fax:215-640-0912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS014349L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery