MEDICARE: JAY IAN SHAW DDS INC

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	261QD0000X	Dental Clinic/Center	OH 14861	OH

General Provider Information

NPI Number	:	1154428589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY IAN SHAW DDS INC

Provider Business Mailing Address
First Line	:	2278 LEE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118
Country	:	US
Telephone Number	:	216-321-9399
Fax Number	:

Provider Business Practice Location Address
First Line	:	2278 LEE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3433
Country	:	US
Telephone Number	:	216-321-9399
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAY SHAW
Credential	:	DDS
Telephone Number	:	216-321-9399

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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