Krisan Shaw, D.D.S.
Individual provider Active NPI General Practice Dentistry · Ellsworth, WI
NPI 1730219239 · NPPES record last updated Aug 16, 2026
Key facts
- NPI
- 1730219239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5175-015 (WI)
- Practice address
- 501 W. Lucas Lane
Ellsworth, WI 54011 - Phone
- (715) 273-3700
- Fax
- (715) 273-1700
- NPI assigned
- Mar 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5175-015 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shaw Family Dental SC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5175-015 | WI | Yes |
Addresses
Primary practice location
501 W. Lucas Lane
Ellsworth, WI 54011
Mailing address
PO Box 310
501 W. Lucas Lane
Ellsworth, WI 54011
Phone (715) 273-3700
Other providers in Ellsworth, WI
- Jessica Puhrmann
- Julie L Raethke
- Leah Mary Ramos
- Ritzinger Optometric Clinic, S.C.
- Shaw Family Dental SC
- Daniel Richard Sherry
- Shopko Stores Operating Co LLC
- Evangeline Desideria Sigwarth
- Kristie F Simmons
- Barbara E Tashjian
All providers in Ellsworth, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.