Healthcare Provider Details

I. General information

NPI: 1831715044
Provider Name (Legal Business Name): MICHAEL SHAW DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4259 W SWAMP RD STE 104
DOYLESTOWN PA
18902-1033
US

IV. Provider business mailing address

83 ARBOR CIR
COLMAR PA
18915-9605
US

V. Phone/Fax

Practice location:
  • Phone: 215-285-1174
  • Fax:
Mailing address:
  • Phone: 215-285-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS042712
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: