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General NPI Number Information
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NPI Number | 1053866947
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Entity Type | Organization
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Legal Business Name | TIMBERLAKE SHAW PLLC
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 4522 15TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98105-4507
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Country | US
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Telephone | 206-523-2025
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Fax | 206-525-6956
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Provider Business Mailing Address
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Address Line | 4522 15TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98105-4507
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Country | US
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Telephone | 206-523-2025
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Fax | 206-525-6956
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SCOTT GALLAGHER SHAW
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Credential | DDS
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Telephone | 206-523-2025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE 60035235
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License Number State | WA
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