MEDICARE: MARGARET SHAW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22807	TX

General Provider Information

NPI Number	:	1326106816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET SHAW

Provider Business Mailing Address
First Line	:	4012 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3520
Country	:	US
Telephone Number	:	214-528-2336
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 S AUSTIN AVE
Second Line	:	STE 101
City	:	DENISON
State	:	TX
Zip	:	75020-7741
Country	:	US
Telephone Number	:	903-327-8540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	05/09/2013

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