NPI 1154765899

Shaw DDS Dental Corporation

Organisation Preferred Provider Organization Los Angeles, CA

Practice location

Address: 5220 W Washington Blvd 103, Los Angeles, CA 90016
Phone: (323) 933-5641
Fax: (323) 939-6620
Mailing address: 5220 W Washington Blvd 103, Los Angeles, CA 90016-1331

Authorised official

Name: Rochelle R Skinner
Title: President
Phone: (323) 933-5641

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 54813 (CA)

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Registry record

NPI: 1154765899
Entity type: Organization
NPI issued: 24 Apr 2013
Record last updated: 25 Oct 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.