Provider Demographics
NPI:1194738997
Name:SHAW, LYNN CARLTON (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:CARLTON
Last Name:SHAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 N GRIMES ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1254
Mailing Address - Country:US
Mailing Address - Phone:505-392-7565
Mailing Address - Fax:
Practice Address - Street 1:3218 N GRIMES ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1254
Practice Address - Country:US
Practice Address - Phone:505-392-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88146Medicaid