Healthcare Provider Details

I. General information

NPI: 1407784028
Provider Name (Legal Business Name): GRAHAM SHADWICK, DDS, A CALIFORNIA PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 BUENA VISTA DR STE 110
PASO ROBLES CA
93446-8581
US

IV. Provider business mailing address

2727 BUENA VISTA DR STE 110
PASO ROBLES CA
93446-8581
US

V. Phone/Fax

Practice location:
  • Phone: 805-231-1118
  • Fax:
Mailing address:
  • Phone: 805-231-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GRAHAM SHADWICK
Title or Position: OWNER
Credential: DDS
Phone: 913-744-7442