Shaw, Mark Alan

Shaw, Mark Alan is an sole proprietor health care provider with primary practice located at 2062 College Ave , Elmira Heights NY 14903-1651. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Shaw, Mark Alan can be contacted via phone (607) 734-7787.

Contact Information

Primary practice address
2062 College Ave Elmira Heights NY 14903-1651
Phone: (607) 734-7787
Fax: (607) 734-2496
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 0453861 New York

Profile Details

NPI number 1831202068
LBN Legal business name Shaw, Mark Alan
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 15th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831202068 NPPES
New York MEDICAID 02241734

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