# JONATHAN R SHAW DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982711818
- **Authorized official:** DR. JONATHAN R SHAW DDS (PRESIDENT OF CORP)
- **Authorized official phone:** (509) 684-6138

## Contact information

- **Practice address:** 214 WEST BIRCH, COLVILLE, WA 99114
- **Practice address phone:** (509) 684-6138
- **Practice address fax:** (509) 684-0884
- **Mailing address:** 214 WEST BIRCH, COLVILLE, WA 99114
- **Mailing address phone:** (509) 684-6138
- **Mailing address fax:** (509) 684-0884

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4798 | WA | Yes |

## Other

- **Enumeration date:** 08/24/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5503107 | — | WA |
| 01 | — | 784537 | UNITED CONCORDIA INS | WA |