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General NPI Number Information
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NPI Number | 1992930226
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Entity Type | Individual
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Provider Name | SCOTT GALLAGHER SHAW DDS
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Gender | Male
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 2704 171ST PL NE
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City | MARYSVILLE
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State | WA
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Zip | 98271
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Country | US
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Telephone | 206-769-0903
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Fax |
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Provider Business Mailing Address
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Address Line | 3372 COLUMBUS LN
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City | ANN ARBOR
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State | MI
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Zip | 48103-2788
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Country | US
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Telephone | 206-769-0903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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