Provider Demographics
NPI:1306544390
Name:SHAW, MAX HARRISON (DDS)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:HARRISON
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 1:6601 RAVENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1698
Mailing Address - Country:US
Mailing Address - Phone:806-358-7633
Mailing Address - Fax:
Practice Address - Street 1:6601 RAVENWOOD CT
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1698
Practice Address - Country:US
Practice Address - Phone:806-358-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty