Provider Demographics
NPI:1043650377
Name:SHAW, F. ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:F.
Middle Name:ALLEN
Last Name:SHAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6743 BEAVER TRL
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-3836
Mailing Address - Country:US
Mailing Address - Phone:706-561-5970
Mailing Address - Fax:
Practice Address - Street 1:6743 BEAVER TRL
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-3836
Practice Address - Country:US
Practice Address - Phone:706-561-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0079281223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health