MEDICARE: MR. STEPHEN O SHAW DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9043	TN
2	1223G0001X	General Practice Dentistry	DN012825	GA

General Provider Information

NPI Number	:	1215139183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN O SHAW DDS

Provider Business Mailing Address
First Line	:	4203 CLOUD SPRINGS RD
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736
Country	:	US
Telephone Number	:	706-891-2008
Fax Number	:	706-820-6756

Provider Business Practice Location Address
First Line	:	4203 CLOUD SPRINGS RD
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736
Country	:	US
Telephone Number	:	706-891-2008
Fax Number	:	706-820-6756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	05/11/2012

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