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General NPI Number Information
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NPI Number | 1043650377
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Entity Type | Individual
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Provider Name | F. ALLEN SHAW D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 6743 BEAVER TRL
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City | MIDLAND
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State | GA
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Zip | 31820-3836
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Country | US
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Telephone | 706-561-5970
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Fax |
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Provider Business Mailing Address
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Address Line | 6743 BEAVER TRL
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City | MIDLAND
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State | GA
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Zip | 31820-3836
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Country | US
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Telephone | 706-561-5970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 007928
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License Number State | GA
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