Provider Demographics
NPI:1326106816
Name:SHAW, MARGARET
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3520
Mailing Address - Country:US
Mailing Address - Phone:214-528-2336
Mailing Address - Fax:
Practice Address - Street 1:2415 S AUSTIN AVE
Practice Address - Street 2:STE 101
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-7741
Practice Address - Country:US
Practice Address - Phone:903-327-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice