MEDICARE: DR. NICHOLAS SHAW 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	390200000X	Student in an Organized Health Care Education/Training Program		IA

General Provider Information

NPI Number	:	1710811641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS SHAW DDS

Provider Business Mailing Address
First Line	:	3700 WESTOWN PKWY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1029
Country	:	US
Telephone Number	:	515-225-6742
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 WESTOWN PKWY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1029
Country	:	US
Telephone Number	:	515-225-6742
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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