Provider Demographics
NPI:1528158789
Name:DRS. SHAW ELY & DUBOS
Entity type:Organization
Organization Name:DRS. SHAW ELY & DUBOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KARSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-474-1900
Mailing Address - Street 1:1200 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113
Mailing Address - Country:US
Mailing Address - Phone:740-474-1900
Mailing Address - Fax:740-474-3991
Practice Address - Street 1:1200 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113
Practice Address - Country:US
Practice Address - Phone:740-474-1900
Practice Address - Fax:740-474-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2220939Medicaid
89198Medicare UPIN