MEDICARE: PAUL NICHOLAS SHAHWAN DDS

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	25403	TX

General Provider Information

NPI Number	:	1598084949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL NICHOLAS SHAHWAN DDS

Provider Business Mailing Address
First Line	:	7301 STATE HIGHWAY 161
Second Line	:	SUITE 198
City	:	IRVING
State	:	TX
Zip	:	75039-2816
Country	:	US
Telephone Number	:	972-869-3789
Fax Number	:

Provider Business Practice Location Address
First Line	:	639 SHERRY LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-4018
Country	:	US
Telephone Number	:	817-737-7711
Fax Number	:

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

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	05/25/2010

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