NPIMap

Organization Active NPI

Bridgeport Dental Arts

  • Dentist
  • University Place, WA
National Provider Identifier
1265535652
Registry record updated Oct 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00006436 Issued in WA
Legal business name
BRIDGEPORT DENTAL ARTS
Practice address
4103 Bridgeport Way W
Suite a
University Place, WA 98466
Phone
(253) 565-4474
Fax
(253) 565-6848
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2014

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

Authorized official

Name
Gary R Shaw, DDSNPI 1154587087
Title
Dentist Owner
Phone
(253) 565-4474

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DE00006436 WA Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 1431549922 UT

Addresses

Primary practice location

4103 Bridgeport Way W
Suite a
University Place, WA 98466

Mailing address

4103 Bridgeport Way W
Suite a
University Place, WA 98466
Phone (253) 565-4474

Other identifiers 1

IdentifierTypeStateIssuer
601484620OtherWAWASTEMPLOYMENT

Other names 1

  • Gary R Shaw DDS Other name

National Provider Directory

National Provider Directory

Locations

4103 Bridgeport Way W
Ste A
University Place, WA 98466
Phone (253) 565-4474

Practitioners & affiliated clinicians

Practitioners 1

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": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412726400000",
    "number": "1265535652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 BRIDGEPORT WAY W",
            "address_2": "SUITE A",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "98466",
            "telephone_number": "253-565-4474",
            "fax_number": "253-565-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 BRIDGEPORT WAY W",
            "address_2": "SUITE A",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "98466",
            "telephone_number": "253-565-4474",
            "fax_number": "253-565-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT DENTAL ARTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2014-10-08",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "253-565-4474",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00006436",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "1431549922",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASTEMPLOYMENT",
            "identifier": "601484620",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gary R Shaw DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; 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.