Provider Demographics
NPI:1538368071
Name:SHAW, WALTER JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JAMES
Last Name:SHAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 W WASHINGTON BLVD
Mailing Address - Street 2:103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-1331
Mailing Address - Country:US
Mailing Address - Phone:323-933-5641
Mailing Address - Fax:323-939-6620
Practice Address - Street 1:5220 W WASHINGTON BLVD
Practice Address - Street 2:103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-1331
Practice Address - Country:US
Practice Address - Phone:323-933-5641
Practice Address - Fax:323-939-6620
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice