MEDICARE: DR. ROBERT R SHAW D.M.D.

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	1223G0001X	General Practice Dentistry	5617	WA

General Provider Information

NPI Number	:	1255334025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT R SHAW D.M.D.

Provider Business Mailing Address
First Line	:	2700 S SOUTHEAST BLVD
Second Line	:	STE 101
City	:	SPOKANE
State	:	WA
Zip	:	99223-4984
Country	:	US
Telephone Number	:	509-747-8779
Fax Number	:	509-462-3043

Provider Business Practice Location Address
First Line	:	2700 S SOUTHEAST BLVD
Second Line	:	STE 101
City	:	SPOKANE
State	:	WA
Zip	:	99223-4984
Country	:	US
Telephone Number	:	509-747-8779
Fax Number	:	509-462-3043

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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