Provider Demographics
NPI:1770599250
Name:SHAW, MARILYN KAYE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:KAYE
Last Name:SHAW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LOTTIE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2995
Mailing Address - Country:US
Mailing Address - Phone:251-928-2727
Mailing Address - Fax:
Practice Address - Street 1:106 LOTTIE LN
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2995
Practice Address - Country:US
Practice Address - Phone:251-928-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51090277Medicare UPIN