Provider Demographics
NPI:1689676322
Name:SHAW, ROBERT ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:SHAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10670 N CENTRAL EXPY
Mailing Address - Street 2:STE 525
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2111
Mailing Address - Country:US
Mailing Address - Phone:214-341-9306
Mailing Address - Fax:214-341-3262
Practice Address - Street 1:10670 N CENTRAL EXPY
Practice Address - Street 2:STE 525
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2111
Practice Address - Country:US
Practice Address - Phone:214-341-9306
Practice Address - Fax:214-341-3262
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist