MEDICARE: DR. ALLAN S. 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS014349L	PA

General Provider Information

NPI Number	:	1871525485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN S. SHAW DDS

Provider Business Mailing Address
First Line	:	1601 WALNUT ST
Second Line	:	SUITE #1116
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2944
Country	:	US
Telephone Number	:	215-640-0811
Fax Number	:	215-640-0912

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST
Second Line	:	SUITE #1116
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2944
Country	:	US
Telephone Number	:	215-640-0811
Fax Number	:	215-640-0912

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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