Dr. Malcolm Drew Shabo, D.D.S.
Dentist, General Practice in Ooltewah, TN. Individual provider (NPI-1).
NPI number1790804367
StatusActive
Last updated in NPPESFeb 25, 2013
Details
- NPI
- 1790804367
- Entity type
- Individual (NPI-1)
- Name
- Dr. Malcolm Drew Shabo
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 28, 2007
- Last updated
- Feb 25, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 7631 | TN | Yes |
Practice location
5958 Snow Hill RdSte 144 Pmb 204
Ooltewah, TN 37363-7833
Phone 423-894-4084 · Fax 423-894-4086
Mailing address
8307 Watersbend LnOoltewah, TN 37363-8705
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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