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Organization
JONATHAN R SHAW DDS PS
Active
Organization
JONATHAN R SHAW DDS PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN R SHAW DDS (PRESIDENT OF CORP)
(509) 684-6138
Entity
Organization
Contact information
Practice address
214 WEST BIRCH, COLVILLE, WA 99114
(509) 684-6138
(509) 684-0884
Mailing address
214 WEST BIRCH, COLVILLE, WA 99114
(509) 684-6138
(509) 684-0884
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4798
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5503107
—
WA
01
—
784537
UNITED CONCORDIA INS
WA
Enumeration date
08/24/2006
Last updated
08/22/2020
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