Roderick K Shaw III DMD PA

Primary specialty

DentistTaxonomy code 122300000X

License

DN10977 Issued in FL

Legal business name

RODERICK K SHAW III DMD PA

Practice address

255 NE Duval Ave
Madison, FL 32340

Phone

(850) 973-6427

Fax

(850) 973-9646

NPI assigned

May 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kathleen B Shaw, DM

Title

Vice Pres

Phone

(850) 973-6427

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Roderick Kirkpatrick Shaw III, DMD

  • Dentist
  • Madison, FL
  • NPI 1396083515
  NPD (past)

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295949444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 NE DUVAL AVE",
            "city": "MADISON",
            "state": "FL",
            "postal_code": "32340",
            "telephone_number": "850-973-6427",
            "fax_number": "850-973-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 NE DUVAL AVE",
            "city": "MADISON",
            "state": "FL",
            "postal_code": "32340",
            "telephone_number": "850-973-6427",
            "fax_number": "850-973-9646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODERICK K SHAW III DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VICE PRES",
        "authorized_official_telephone_number": "850-973-6427",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DM"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN10977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Charlie E Richardson, M.D.
• Michele B Richardson, ARNP,FNP-BC
• Clint A Rogers, DMD
• Rosa's Caring Heart, LLC
• S&S Senior Housing of Madison LLC.
• Safe Harbor for Individual With Disabilities
• Kimberly M. Sanders, P.T.

• Dentist in Madison, FL
• Providers in Madison, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.