NPIMap

Organization Active NPI

Shaw DDS Dental Corporation

  • Preferred Provider Organization
  • Los Angeles, CA
National Provider Identifier
1154765899
Registry record updated Oct 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
54813 Issued in CA
Legal business name
SHAW DDS DENTAL CORPORATION
Practice address
5220 W Washington Blvd
103
Los Angeles, CA 90016
Phone
(323) 933-5641
Fax
(323) 939-6620
NPI assigned
Apr 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rochelle R Skinner, D.D.S.
Title
President
Phone
(323) 933-5641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 54813 CA Primary

Addresses

Primary practice location

5220 W Washington Blvd
103
Los Angeles, CA 90016

Mailing address

5220 W Washington Blvd
103
Los Angeles, CA 90016-1331
Phone (323) 933-5641

National Provider Directory

National Provider Directory

Locations

5220 W Washington Blvd
Ste 103
Los Angeles, CA 90016
Phone (323) 933-5641

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382659200000",
    "number": "1154765899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 W WASHINGTON BLVD",
            "address_2": "103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900161331",
            "telephone_number": "323-933-5641",
            "fax_number": "323-939-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 W WASHINGTON BLVD",
            "address_2": "103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90016",
            "telephone_number": "323-933-5641",
            "fax_number": "323-939-6620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAW DDS DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-24",
        "last_updated": "2013-10-25",
        "status": "A",
        "authorized_official_last_name": "SKINNER",
        "authorized_official_first_name": "ROCHELLE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-933-5641",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "54813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.