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General NPI Number Information
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NPI Number | 1073716338
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Entity Type | Organization
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Legal Business Name | FREDRICK SHAW DDS, PC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1500 W 38TH ST STE. 34
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City | AUSTIN
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State | TX
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Zip | 78731-6321
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Country | US
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Telephone | 512-451-7491
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Fax | 512-451-5388
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Provider Business Mailing Address
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Address Line | 1500 W 38TH ST STE. 34
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City | AUSTIN
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State | TX
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Zip | 78731-6321
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Country | US
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Telephone | 512-451-7491
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Fax | 512-451-5388
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MR. ADRIAN F RAMOS
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Credential |
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Telephone | 512-451-7491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 17867
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License Number State | TX
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