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General NPI Number Information
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NPI Number | 1851789820
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Entity Type | Individual
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Provider Name | DOUGLAS ROBERT SHAW D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 3303 N CENTRAL EXPY STE 250
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City | PLANO
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State | TX
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Zip | 75023-6912
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Country | US
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Telephone | 801-230-4643
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Fax |
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Provider Business Mailing Address
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Address Line | 309 SUNCREEK DR
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City | ALLEN
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State | TX
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Zip | 75013-2835
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Country | US
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Telephone | 801-230-4643
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30541
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License Number State | TX
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