MEDICARE: STEVEN SHAW DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6851	NV

General Provider Information

NPI Number	:	1326584954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN SHAW DDS, MS

Provider Business Mailing Address
First Line	:	4610 MEADOWS LN
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2927
Country	:	US
Telephone Number	:	702-482-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 MEADOWS LN
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2927
Country	:	US
Telephone Number	:	702-482-8299
Fax Number	:

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

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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