Kenneth John Shaw, DDS
Individual provider Active NPI General Practice Dentistry · Cotati, CA
NPI 1801988167 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1801988167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 27067 (CA)
- Practice address
- 8125 La PLZ
Cotati, CA 94931-4244 - Phone
- (707) 795-6424
- Fax
- (707) 795-4294
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 27067 | CA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 27067 | CA | Yes |
Addresses
Primary practice location
8125 La PLZ
Cotati, CA 94931-4244
Mailing address
8125 La PLZ
Cotati, CA 94931-4244
Phone (707) 795-6424
Other providers in Cotati, CA
- Soraya Saffarinia
- Monica Monzerrat Salas-Diaz
- Cristin Seppa
- Raahul Anuj Shah
- Farahnaz Shams Baragh
- Colin Smith
- Majerle Suitts
- Sunflower Doula LLC
- Teaching Living Concepts Inc
- Amy Thomas
All providers in Cotati, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.