Randolph S Shaw, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17879 Issued in OH

Practice address

1080 Union Blvd
Englewood, OH 45322-2223

Phone

(937) 836-7592

Fax

(937) 836-6269

NPI assigned

Mar 28, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710006218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 UNION BLVD",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "453222223",
            "telephone_number": "937-836-7592",
            "fax_number": "937-836-6269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 UNION BLVD",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "453222223",
            "telephone_number": "937-836-7592",
            "fax_number": "937-836-6269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "RANDOLPH",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "17879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Wrightsmen Shaffer, D.C.
• Shank Chiropractic Clinic LLC
• Ryan A Shank, D.C.
• Seema Sharma, M.D.
• Melinda Shaw
• Ross D. Shira, DDS
• Shontae L Howard
• Rebecca G Shreck, LISW, LCDCIII
• Amy Kathleen Shuttleworth, RPH
• Rachel Elizabeth Sidwell, MD

• General Practice Dentistry in Englewood, OH
• Providers in Englewood, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.