Provider Demographics
NPI:1073716338
Name:FREDRICK SHAW DDS, PC
Entity Type:Organization
Organization Name:FREDRICK SHAW DDS, PC
Other - Org Name:SHOAL CREEK PROSTHODONTIC GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-451-7491
Mailing Address - Street 1:1500 W 38TH ST
Mailing Address - Street 2:STE. 34
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6321
Mailing Address - Country:US
Mailing Address - Phone:512-451-7491
Mailing Address - Fax:512-451-5388
Practice Address - Street 1:1500 W 38TH ST
Practice Address - Street 2:STE. 34
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6321
Practice Address - Country:US
Practice Address - Phone:512-451-7491
Practice Address - Fax:512-451-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178671223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty