=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518176254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENISE TAYLOR-SHAW DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 10/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8630 FENTON ST SUITE 210
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-589-8110
-----------------------------------------------------
Fax | 301-589-2900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8630 FENTON ST SUITE 210
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-589-8110
-----------------------------------------------------
Fax | 301-589-2900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DENISE TAYLOR-SHAW TAYLOR-SHAW
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 301-589-8110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3643
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 9445
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------