Provider Demographics
NPI:1679594113
Name:SHAW, MICHAEL P (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:SHAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:222 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-7272
Mailing Address - Country:US
Mailing Address - Phone:209-667-9339
Mailing Address - Fax:209-664-0505
Practice Address - Street 1:2020 STANDIFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6530
Practice Address - Country:US
Practice Address - Phone:209-525-9339
Practice Address - Fax:209-525-9366
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADW0359961223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology