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Organization
BRIDGEPORT DENTAL ARTS
Active
Organization
BRIDGEPORT DENTAL ARTS
Active
Other names
Gary R Shaw DDS
Organization subpart
No
Provider details
NPI number
Authorized official
GARY R SHAW DDS (DENTIST OWNER)
(253) 565-4474
Entity
Organization
Contact information
Practice address
4103 BRIDGEPORT WAY W, SUITE A, UNIVERSITY PLACE, WA 98466
(253) 565-4474
(253) 565-6848
Mailing address
4103 BRIDGEPORT WAY W, SUITE A, UNIVERSITY PLACE, WA 98466
(253) 565-4474
(253) 565-6848
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1431549922
UT
122300000X
Dentist
Primary
DE00006436
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
601484620
WASTEMPLOYMENT
WA
Enumeration date
09/07/2006
Last updated
10/08/2014
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