Provider Demographics
NPI:1497865265
Name:SHAVE, FREDERICK W (DDS FAGD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:W
Last Name:SHAVE
Suffix:
Gender:M
Credentials:DDS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N JOSEY LANE SUITE 238
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6104
Mailing Address - Country:US
Mailing Address - Phone:972-418-8461
Mailing Address - Fax:972-418-8462
Practice Address - Street 1:1212 N JOSEY LANE SUITE 238
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6104
Practice Address - Country:US
Practice Address - Phone:972-418-8461
Practice Address - Fax:972-418-8462
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
742487OtherUNITED CONCORDIA
TXD09949OtherBCBS