Organization
JERRY L. SHAW, D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY L. SHAW DDS (OWNER)
(801) 731-4850
Entity
Organization
Contact information
Practice address
1761 N. 2000 W., FARR WEST, UT 84404-9541
(801) 731-4850
(801) 731-4852
Mailing address
1761 N. 2000 W., FARR WEST, UT 84404-9541
(801) 731-4850
(801) 731-4852
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
132357
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529447754018
—
UT
Enumeration date
10/19/2011
Last updated
10/19/2011
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