MEDICARE: DR. EDWARD GARY SHAIVITZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	5236	MD

General Provider Information

NPI Number	:	1093932592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD GARY SHAIVITZ D.D.S.

Provider Business Mailing Address
First Line	:	14333 LAUREL BOWIE RD STE 306
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-1183
Country	:	US
Telephone Number	:	301-490-5555
Fax Number	:	301-490-5308

Provider Business Practice Location Address
First Line	:	14333 LAUREL BOWIE RD STE 306
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-1183
Country	:	US
Telephone Number	:	301-490-5555
Fax Number	:	301-490-5308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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