# BRIDGEPORT DENTAL ARTS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gary R Shaw DDS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265535652
- **Authorized official:** GARY R SHAW DDS (DENTIST OWNER)
- **Authorized official phone:** (253) 565-4474

## Contact information

- **Practice address:** 4103 BRIDGEPORT WAY W, SUITE A, UNIVERSITY PLACE, WA 98466
- **Practice address phone:** (253) 565-4474
- **Practice address fax:** (253) 565-6848
- **Mailing address:** 4103 BRIDGEPORT WAY W, SUITE A, UNIVERSITY PLACE, WA 98466
- **Mailing address phone:** (253) 565-4474
- **Mailing address fax:** (253) 565-6848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 1431549922 | UT | — |
| 122300000X | Dentist | DE00006436 | WA | Yes |

## Other

- **Enumeration date:** 09/07/2006
- **Last updated:** 10/08/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 601484620 | WASTEMPLOYMENT | WA |